Peripheral arterial disease natural history, complications and prognosis: Difference between revisions
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{{Peripheral arterial disease}} | {{Peripheral arterial disease}} | ||
{{CMG}}; | |||
{{AE}} {{CZ}} {{AN}} | |||
==Overview== | ==Overview== | ||
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* All patients with PAD should be targeted with the same secondary prevention goals as patients with [[coronary artery disease]]. | * 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 | * Peripheral arterial disease is a true coronary risk equivalent | ||
===5 year primary patency rates=== | |||
{| style="width:60%; height:100px" border="1" align="center" | |||
|- | |||
|'''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== | ==References== | ||
Revision as of 16:00, 12 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
Natural History
- An accurate history is the key to the diagnosis of PAD
- Eliciting atherosclerotic risk factors in the history may help to identify patients, who although asymptomatic, have evidence of PAD on physical examination or noninvasive testing.
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% |