Peripheral arterial disease
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Peripheral arterial disease is a common and debilitating condition.
Epidemiology
The age-adjusted prevalence of peripheral arterial disease is approximately 12% 3.
Pathology
Atherosclerosis is the leading cause of occlusive arterial disease of the extremities in patients over 40 years of age with the highest incidence in the sixth and seventh decades of life.
Risk factors
The risk factors for PAD are basically the same as for coronary artery disease:
- diabetes mellitus
- cigarette smoking
- advancing age
- hypercholesterolaemia
- hypertension
- overweight
/ obesity/obesity
Clinical classification
The Rutherford classification
-
stage 0:
-asymptomatic -
stage 1:
-mild claudication -
stage 2:
-moderate claudication : the distance that delineates mild, moderate and severe claudication is not specified in the Rutherford classification, but is mentioned in the Fontaine classification as 200 meters. -
stage 3:
-severe claudication -
stage 4:
-rest pain -
stage 5:
-ischaemic ulceration not exceeding ulcer of the digits of the foot -
stage 6:
-severe ischemic ulcers or frank gangrene
The Fontaine classification
-
stage I:
-asymptomatic. -
stage II:
-intermittent claudication.- stage IIa: intermittent claudication after more than 200 meters of pain free walking.
- stage IIb: intermittent claudication after less than 200 meters of walking
-
stage III:
-rest pain. -
stave IV:
-ischaemic ulcers or gangrene
TASC II classification of femoral and popliteal lesions 4
-
type A lesions
- single stenosis
≤ 10≤10 cm in length - single occlusion
≤ 5≤5 cm in length
- single stenosis
-
type B lesions
- multiple lesions (stenoses or occlusions), each
≤ 5≤5 cm - single stenosis or occlusion
≤ 15≤15 cm not involving the infrageniculate popliteal artery - single or multiple lesions in the absence of continous tibial vessels to improve inflow for a distal bypass
- heavily calcified occlusion
≤ 5cm≤5cm in length - single popliteal stenosis
- multiple lesions (stenoses or occlusions), each
-
type C lesions
- multiple stenoses or occlusions totaling >
; 15;15 cm with or without heavy calcification - recurrent stenoses or occlusions that need treatment after two endovascular interventions
- multiple stenoses or occlusions totaling >
-
type D lesions
- chronic total occlusion of the common or superficial femoral artery (>
; 20;20 cm, involving the popliteal artery) - chronic total occlusion of the popliteal artery and proximal trifurcation vessels
- chronic total occlusion of the common or superficial femoral artery (>
Radiographic features
Plain film
May show calcified atherosclerotic plaques along vessels
Angiography
In angiogramms (DSA [gold standard], CT, MRI) you can identifiy and quantify the stenoses.
Treatment and prognosis
Primary treatment strategy according TASC severity
-
TASC A:
-endovascular therapy -
TASC B:
-endovascular therapy -
TASC C:
-surgical therapy (if patient is able to be operated, otherwise endovascular therapy) -
TASC D:
-surgical therapy
-<p><strong>Peripheral arterial disease</strong> is a common and debilitating condition.</p><h4>Epidemiology</h4><p>The age-adjusted prevalence of peripheral arterial disease is approximately 12% <sup>3</sup>.</p><h4>Pathology</h4><p><a href="/articles/arteriosclerosis_&_hypertension">Atherosclerosis</a> is the leading cause of occlusive arterial disease of the extremities in patients over 40 years of age with the highest incidence in the sixth and seventh decades of life.</p><h5>Risk factors</h5><p>The risk factors for PAD are basically the same as for coronary artery disease:</p><ul>- +<p><strong>Peripheral arterial disease</strong> is a common and debilitating condition.</p><h4>Epidemiology</h4><p>The age-adjusted prevalence of peripheral arterial disease is approximately 12% <sup>3</sup>.</p><h4>Pathology</h4><p><a href="/articles/arteriosclerosis">Atherosclerosis</a> is the leading cause of occlusive arterial disease of the extremities in patients over 40 years of age with the highest incidence in the sixth and seventh decades of life.</p><h5>Risk factors</h5><p>The risk factors for PAD are basically the same as for coronary artery disease:</p><ul>
-<li>overweight / obesity</li>- +<li>overweight/obesity</li>
-<strong>stage 0</strong> - asymptomatic</li>- +<strong>stage 0:</strong> asymptomatic</li>
-<strong>stage 1</strong> - mild claudication</li>- +<strong>stage 1:</strong> mild claudication</li>
-<strong>stage 2</strong> - moderate claudication : the distance that delineates mild, moderate and severe claudication is not specified in the Rutherford classification, but is mentioned in the Fontaine classification as 200 meters.</li>- +<strong>stage 2:</strong> moderate claudication : the distance that delineates mild, moderate and severe claudication is not specified in the Rutherford classification, but is mentioned in the Fontaine classification as 200 meters</li>
-<strong>stage 3</strong> - severe claudication</li>- +<strong>stage 3:</strong> severe claudication</li>
-<strong>stage 4</strong> - rest pain</li>- +<strong>stage 4:</strong> rest pain</li>
-<strong>stage 5</strong> - ischaemic ulceration not exceeding ulcer of the digits of the foot</li>- +<strong>stage 5:</strong> ischaemic ulceration not exceeding ulcer of the digits of the foot</li>
-<strong>stage 6</strong> - severe ischemic ulcers or frank gangrene</li>- +<strong>stage 6:</strong> severe ischemic ulcers or frank gangrene</li>
-<strong>stage I </strong>- asymptomatic.</li>- +<strong>stage I:</strong> asymptomatic.</li>
-<strong>stage II</strong> - intermittent claudication.<ul>-<li>stage IIa : intermittent claudication after more than 200 meters of pain free walking.</li>-<li>stage IIb : intermittent claudication after less than 200 meters of walking</li>- +<strong>stage II:</strong> intermittent claudication.<ul>
- +<li>stage IIa: intermittent claudication after more than 200 meters of pain free walking.</li>
- +<li>stage IIb: intermittent claudication after less than 200 meters of walking</li>
-<strong>stage III</strong> - rest pain.</li>- +<strong>stage III:</strong> rest pain.</li>
-<strong>stave IV</strong> - ischaemic ulcers or gangrene</li>- +<strong>stave IV:</strong> ischaemic ulcers or gangrene</li>
-<li>single stenosis ≤ 10 cm in length</li>-<li>single occlusion ≤ 5 cm in length</li>- +<li>single stenosis ≤10 cm in length</li>
- +<li>single occlusion ≤5 cm in length</li>
-<li>multiple lesions (stenoses or occlusions), each ≤ 5 cm</li>-<li>single stenosis or occlusion ≤ 15 cm not involving the infrageniculate popliteal artery</li>- +<li>multiple lesions (stenoses or occlusions), each ≤5 cm</li>
- +<li>single stenosis or occlusion ≤15 cm not involving the infrageniculate popliteal artery</li>
-<li>heavily calcified occlusion ≤ 5cm in length</li>- +<li>heavily calcified occlusion ≤5cm in length</li>
-<li>multiple stenoses or occlusions totaling > 15 cm with or without heavy calcification</li>- +<li>multiple stenoses or occlusions totaling >15 cm with or without heavy calcification</li>
-<li>chronic total occlusion of the common or superficial femoral artery (> 20 cm, involving the popliteal artery)</li>- +<li>chronic total occlusion of the common or superficial femoral artery (>20 cm, involving the popliteal artery)</li>
-<strong>TASC A </strong>- endovascular therapy</li>- +<strong>TASC A:</strong> endovascular therapy</li>
-<strong>TASC B</strong> - endovascular therapy</li>- +<strong>TASC B:</strong> endovascular therapy</li>
-<strong>TASC C</strong> - surgical therapy (if patient is able to be operated, otherwise endovascular therapy)</li>- +<strong>TASC C:</strong> surgical therapy (if patient is able to be operated, otherwise endovascular therapy)</li>
-<strong>TASC D </strong>- surgical therapy</li>- +<strong>TASC D:</strong> surgical therapy</li>
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