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> | * 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> | ||
* Lifestyle modifications and medical management is sufficient to treat asymptomatic to mild PAD. However, sever [[ischemia]] requires revascularization surgeries as definitve treatment. | * Lifestyle modifications and medical management is sufficient to treat asymptomatic to mild PAD. However, sever [[ischemia]] requires revascularization surgeries as definitve treatment. | ||
===Mortality=== | |||
* Patients with [[peripheral arterial disease]] have a 15 to 30 % five year mortality rate, which is two to six times higher than the general population. | |||
* The mortality associated with the [[peripheral vascular disease]] is rarely directly related to the disease itself but it is rather related to the co-existing coronary and cerebrovascular diseases<ref name="Wennberg">Wennberg PW, Rooke TW. Chapter 109. Diagnosis and Management of Diseases of the Peripheral Arteries and Veins. In: Fuster V, Walsh RA, Harrington RA, eds. Hurst's The Heart. 13th ed. New York: McGraw-Hill; 2011.</ref>. | |||
**Presence of [[peripheral arterial disease]] in a patient corelates strongly with high cardiovascular and cerebrovascular mortality <ref name="pmid22477268">{{cite journal |author=Dhaliwal G, Mukherjee D |title=Peripheral arterial disease: Epidemiology, natural history, diagnosis and treatment |journal=[[The International Journal of Angiology : Official Publication of the International College of Angiology, Inc]] |volume=16 |issue=2 |pages=36–44 |year=2007 |pmid=22477268 |pmc=2733014 |doi= |url=}}</ref> | |||
** 30 to 50% of the patients with symptomatic [[PAD]] have evidence of [[coronary artery disease]], whereas 15% to 25% of symptomatic PAD patients have evidence of significant [[carotid artery stenosis]] <ref name="pmid9560072">{{cite journal |author=Mendelson G, Aronow WS, Ahn C |title=Prevalence of coronary artery disease, atherothrombotic brain infarction, and peripheral arterial disease: associated risk factors in older Hispanics in an academic hospital-based geriatrics practice |journal=[[Journal of the American Geriatrics Society]] |volume=46 |issue=4 |pages=481–3 |year=1998 |month=April |pmid=9560072 |doi= |url=}}</ref>. | |||
====The factors that influence the mortality in [[PAD]]==== | |||
*'''Severity of symptoms:''' | |||
**Non critical [[claudication]]: 15-30% five year mortality rate | |||
**Critical [[claudication]] (Limb rest pain, ulcers, [[gangrene]]): 25% one year mortality rate | |||
*'''[[ABI]]:''' | |||
**Normal [[ABI]] in the presence of symptoms: no change in the mortality rate | |||
**[[ABI]]<0.85: 10% five year mortality rate | |||
**[[ABI]]<0.4: 50% one year mortality rate | |||
*'''Tobacco use:''' | |||
**Two fold increase in mortality | |||
*'''[[Diabetes]]:''' | |||
**Increase in all causes of mortality | |||
*'''Location of the arterial occlusive disease:''' | |||
**Aorticoliliac: 73% five year survival | |||
**Femoral: 80% five year survival <ref name="Spittel">Spittel P. Chapter 44. Peripheral vascular Disease. In Murphy J, Lloyd M,Mayo Clinic Cardiology Concise Textbook. Fourth edition.Mayo clinic scientific press.2013</ref> | |||
==Complications== | ==Complications== |
Revision as of 18:19, 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]
- Lifestyle modifications and medical management is sufficient to treat asymptomatic to mild PAD. However, sever ischemia requires revascularization surgeries as definitve treatment.
Mortality
- Patients with peripheral arterial disease have a 15 to 30 % five year mortality rate, which is two to six times higher than the general population.
- The mortality associated with the peripheral vascular disease is rarely directly related to the disease itself but it is rather related to the co-existing coronary and cerebrovascular diseases[2].
- Presence of peripheral arterial disease in a patient corelates strongly with high cardiovascular and cerebrovascular mortality [3]
- 30 to 50% of the patients with symptomatic PAD have evidence of coronary artery disease, whereas 15% to 25% of symptomatic PAD patients have evidence of significant carotid artery stenosis [4].
The factors that influence the mortality in PAD
- Severity of symptoms:
- Non critical claudication: 15-30% five year mortality rate
- Critical claudication (Limb rest pain, ulcers, gangrene): 25% one year mortality rate
- ABI:
- Tobacco use:
- Two fold increase in mortality
- Diabetes:
- Increase in all causes of mortality
- Location of the arterial occlusive disease:
- Aorticoliliac: 73% five year survival
- Femoral: 80% five year survival [5]
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
|month=
ignored (help) - ↑ Wennberg PW, Rooke TW. Chapter 109. Diagnosis and Management of Diseases of the Peripheral Arteries and Veins. In: Fuster V, Walsh RA, Harrington RA, eds. Hurst's The Heart. 13th ed. New York: McGraw-Hill; 2011.
- ↑ Dhaliwal G, Mukherjee D (2007). "Peripheral arterial disease: Epidemiology, natural history, diagnosis and treatment". The International Journal of Angiology : Official Publication of the International College of Angiology, Inc. 16 (2): 36–44. PMC 2733014. PMID 22477268.
- ↑ Mendelson G, Aronow WS, Ahn C (1998). "Prevalence of coronary artery disease, atherothrombotic brain infarction, and peripheral arterial disease: associated risk factors in older Hispanics in an academic hospital-based geriatrics practice". Journal of the American Geriatrics Society. 46 (4): 481–3. PMID 9560072. Unknown parameter
|month=
ignored (help) - ↑ Spittel P. Chapter 44. Peripheral vascular Disease. In Murphy J, Lloyd M,Mayo Clinic Cardiology Concise Textbook. Fourth edition.Mayo clinic scientific press.2013