Peripheral arterial disease natural history, complications and prognosis: Difference between revisions
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== Natural History == | == Natural History == | ||
* 20% to 50% of patients with peripheral arterial disease are asymptomatic <ref name="pmid18458172">{{cite journal |author=McDermott MM, Guralnik JM, Ferrucci L, ''et al.'' |title=Asymptomatic peripheral arterial disease is associated with more adverse lower extremity characteristics than intermittent claudication |journal=[[Circulation]] |volume=117 |issue=19 |pages=2484–91 |year=2008 |month=May |pmid=18458172 |doi=10.1161/CIRCULATIONAHA.107.736108 |url=}}</ref> | |||
==Complications== | ==Complications== | ||
* Blood clots or emboli that block off small arteries | * Blood clots or emboli that block off small arteries |
Revision as of 13:54, 30 October 2012
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Cafer Zorkun, M.D., Ph.D. [2] Aarti Narayan, M.B.B.S [3]
Overview
Most patients with peripheral arterial disease have a benign course, with majority being asymptomatic. However, clinical manifestations may progress rapidly in smokers, and those with diabetes or chronic renal failure.
Natural History
- 20% to 50% of patients with peripheral arterial disease are asymptomatic [1]
Complications
- Blood clots or emboli that block off small arteries
- Coronary artery disease
- Impotence
- Open sores (ischemic ulcers) on the lower legs
- Tissue death (gangrene)
Prognosis
- The diagnosis of PAD places a patient at high risk of major cardiovascular events, specifically myocardial infarction (MI), stroke and death.
- Patients with PAD have a twofold to fourfold increase in the risk of all-cause mortality and a threefold to sixfold increase in the risk of cardiovascular death relative to patients without PAD
- Patients with PAD also have a higher risk of an MI or a stroke than of a limb-related event, such as:
- Lower extremity ulcer
- Gangrene
- Need for amputation
- The risk of a major cardiovascular event is highest among patients with the most severe PAD, such as those with critical limb ischemia, in whom 1-year event rates are as high as 20% to 25%
- All patients with PAD should be targeted with the same secondary prevention goals as patients with coronary artery disease.
- Peripheral arterial disease is a true coronary risk equivalent
5 year primary patency rates
Location | Angioplasty ± Stenting | Bypass grafting |
Distal aorta/ Proximal common iliac artery | 51 - 88% | 80 - 90% |
Distal common iliac artery | 56 - 65% | Vein: 60 - 75%, Synthetic: 55 - 62% |
Proximal external iliac artery | 40 - 56% | Vein: 60 - 70%, Synthetic: 55 - 62% |
Distal external iliac artery | 10 - 40% | Vein: 50 - 60%, Synthetic: 10 - 15% |
References
- ↑ McDermott MM, Guralnik JM, Ferrucci L; et al. (2008). "Asymptomatic peripheral arterial disease is associated with more adverse lower extremity characteristics than intermittent claudication". Circulation. 117 (19): 2484–91. doi:10.1161/CIRCULATIONAHA.107.736108. PMID 18458172. Unknown parameter
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