cardiovascular disorders
Peripheral Arterial Disease
Key Points
Peripheral arterial disease (PAD) occurs almost always in the lower extremities. 50 to 75% of patients also have significant cerebral and/or coronary atherosclerosis. When symptomatic, PAD causes intermittent claudication, which is discomfort in the legs that occurs during walking and is relieved by rest; it is a manifestation of exercise-induced reversible ischemia, similar to angina pectoris. Severe PAD may cause pain during rest, reflecting irreversible ischemia, or ischemic ulcers on the feet. A low (≤0.90) ankle-brachial index (ratio of ankle to arm systolic blood pressure) indicates PAD. Modify atherosclerosis risk factors; give statins, antiplatelet drugs, and sometimes angiotensin-converting enzyme inhibitors,rivaroxaban,pentoxifylline, orcilostazol. Percutaneous transluminal angioplasty with or without stent insertion may dilate vascular occlusions; sometimes surgery (endarterectomy or bypass grafting) is necessary. 