Lower extremity peripheral artery disease: a basic approach

2020 ◽  
Vol 81 (3) ◽  
pp. 1-9
Author(s):  
Keith A Chan ◽  
Alex Junia
Keyword(s):  
Peripheral Artery Disease ◽  
Lifestyle Changes ◽  
Lower Limbs ◽  
Peripheral Artery ◽  
Early Administration ◽  
Pressure Index ◽  
Cardiovascular Morbidity And Mortality ◽  
Artery Disease ◽  
High Degree ◽  
Progressive Disorder

Peripheral artery disease of the lower limbs is a chronically progressive disorder characterised by the presence of occlusive lesions in the medium and large arteries that result in symptoms secondary to insufficient blood flow to the lower extremities. It is both a manifestation of systemic atherosclerosis and a marker of increased cardiovascular morbidity and mortality. Because of its highly heterogenous clinical picture, a detailed history and physical assessment, a high degree of suspicion for peripheral artery disease and the use of the ankle–brachial pressure index is essential to identify patients with peripheral artery disease. This will allow early administration of basic pharmacotherapy and lifestyle changes to reduce cardiovascular events, minimise claudication symptoms and enable optimal revascularisation to prevent loss of limb function.

Novel Oral Anticoagulants in Peripheral Artery Disease: Current Evidence

2019 ◽  
Vol 24 (38) ◽  
pp. 4511-4515 ◽  
Author(s):  
A. Koutsoumpelis ◽  
C. Argyriou ◽  
K.M. Tasopoulou ◽  
E.I. Georgakarakos ◽  
G.S. Georgiadis
Keyword(s):  
Peripheral Artery Disease ◽  
Oral Anticoagulants ◽  
Novel Oral Anticoagulants ◽  
Current Evidence ◽  
Peripheral Artery ◽  
Cardiac Events ◽  
Traditional Therapy ◽  
Cardiovascular Morbidity And Mortality ◽  
Increased Risk ◽  
Artery Disease

Background: Peripheral artery disease is a common manifestation of systemic atherosclerosis which strongly correlates to cardiovascular morbidity and mortality. In addition, the progression of peripheral artery disease leads to an increased risk of limb loss. In order to reduce these events, the benchmark of treatment and research over the last years has been the antiplatelet therapy which aims at inhibition of platelet aggregation. Over the last years, new studies combining antiplatelet agents in different therapeutic schemes have been proven efficacious. Unfortunately, patients remain still at high risk of CV events. Novel Oral Anticoagulants have been introduced as alternatives to warfarin, in the prevention and treatment of venous thromboembolism. The rationale of using medication which acts on platelet activation and the coagulation pathway of thrombosis has led investigators to examine the role of Noac's in preventing CV events in patients with peripheral artery disease, stable or unstable. Methods: The aim of this study is to review the current evidence with respect to recently published studies concerning the use of Novel anticoagulants in peripheral artery disease. Results: The Compass trial has shown that a combination of rivaroxaban with traditional therapy may produce promising results in reducing amputation rates, stroke, cardiac events, and mortality, however, there are still safety issues with bleeding requiring acute care. The ePAD study has provided us with insight concerning safety and efficacy after peripheral angioplasty or stenting and actually the need for further research. The Voyager Pad study, following the steps of Compass, is studying the effect and safety of the addition of rivaroxaban to traditional therapy in the highest risk population aka patients undergoing peripheral revascularization. The evidence concerning patients with concomitant atrial fibrillation appears to be insufficient, however, recent guidelines propose the use of novel oral anticoagulants. Conclusion: For the time being, novel oral anticoagulants in combination with aspirin may provide an alternative treatment in PAD, however, it is deemed necessary to identify patient subgroups who will benefit the most.

scholarly journals Epidemiology of Peripheral Artery Disease of Lower Limbs among Workers to Cotonou in 2013

2017 ◽  
Vol 05 (02) ◽  
Author(s):  
Codjo HL ◽  
Sonou A ◽  
Wanvoegbe A ◽  
Doyigbe M ◽  
Adjagba P ◽  
...  
Keyword(s):  
Peripheral Artery Disease ◽  
Lower Limbs ◽  
Peripheral Artery ◽  
Artery Disease

scholarly journals High prevalence of exercise-induced ischemia in the asymptomatic limb of patients with apparently strictly unilateral symptoms and unilateral peripheral artery disease

2019 ◽  
Vol 13 ◽  
pp. 175394471881906 ◽  
Author(s):  
Samir Henni ◽  
Pascal Bauer ◽  
Tanguy Le Meliner ◽  
Jeanne Hersant ◽  
Xavier Papon ◽  
...  
Keyword(s):  
Pressure Drop ◽  
Peripheral Artery Disease ◽  
Systolic Pressure ◽  
Diabetic Patients ◽  
Peripheral Artery ◽  
Pressure Index ◽  
High Prevalence ◽  
Artery Disease ◽  
Exercise Induced ◽  
Brachial Systolic Pressure

Background: The prevalence of exercise-induced ischemia in the asymptomatic limb of patients with unilateral claudication based on history and treadmill evaluation, and with unilateral ipsilateral peripheral artery disease (i.e ankle-to-brachial systolic pressure index <0.90) is unknown. Methods: We detected exercise-induced ischemia in the asymptomatic limb of patients with apparently unilateral claudication. Among 6059 exercise-oximetry tests performed in 3407 nondiabetic and 961 diabetic patients. We estimated the intensity of ischemia in the both limb (buttocks and calves) using the lowest minimum value of the decrease from rest of oxygen pressure (DROP; limb changes minus chest changes from rest), with significant ischemia defined as DROP lower than −15 mmHg. Results: We found 152 tests performed in 142 nondiabetic patients and 40 tests performed in 38 diabetic patients. The asymptomatic limb showed significant ischemia in 46.7% and 37.5% of the tests. Strictly unilateral exercise-induced claudication with apparently unilateral peripheral artery disease was rare (<4% of all tests). However, among these highly selected tests, significant ischemia was found in the asymptomatic limb in more than one-third of cases. Conclusion: The asymptomatic limb of patients with peripheral artery disease should not be considered a normal limb.

scholarly journals A rare case of sigmoid colon cancer in which the lower limbs received collateral blood flow from the inferior mesenteric artery owing to peripheral artery disease

2021 ◽  
Vol 7 (1) ◽  
Author(s):  
Kyoichi Kihara ◽  
Hiromu Horie ◽  
Kozo Miyatani ◽  
Masayuki Endo ◽  
Tomoyuki Matsunaga ◽  
...  
Keyword(s):  
Colon Cancer ◽  
Sigmoid Colon ◽  
Peripheral Artery Disease ◽  
Mesenteric Artery ◽  
Inferior Mesenteric Artery ◽  
Limb Ischemia ◽  
Lower Limbs ◽  
Sigmoid Colon Cancer ◽  
Peripheral Artery ◽  
Artery Disease

Abstract Background Colorectal cancer and peripheral artery disease are common conditions in older adults and may coexist in this population. Lymph node dissection along the inferior mesenteric artery is a vital procedure in cases of left-sided colorectal cancer. However, the inferior mesenteric artery may show a collateral blood pathway in rare cases of peripheral artery disease. We report a case of advanced sigmoid colon cancer in which the lower limbs received inferior mesenteric artery flow owing to asymptomatic peripheral artery disease. The possibility of catastrophic lower-limb ischemia because of complete mesenteric excision with ligation of the inferior mesenteric artery was a matter of concern in this case. Case presentation A 73-year-old man with asymptomatic peripheral artery disease was diagnosed with stage IIIB advanced sigmoid colon cancer. Angiography using a balloon-occlusion catheter revealed that his lower limbs received prominent inferior mesenteric artery blood flow through a collateral pathway. Therefore, interventional radiologists and cardiovascular surgeons evaluated the indications for endovascular stents or bypass grafts. The patient also had dilated cardiomyopathy, so the cardiovascular physicians evaluated his tolerance in the worst-case scenario of a colorectal anastomotic leak. The patient underwent axillofemoral artery bypass and two-stage laparoscopic sigmoid colectomy without anastomosis. The postoperative course was uneventful, and he resumed his job within a month after the resection. Conclusions Although collateral flow from the inferior mesenteric artery is rare in patients with peripheral artery disease, a few case reports have described fatal lower-limb ischemia following anterior resection. The perioperative multidisciplinary evaluation enabled us to understand the patient’s condition and risks, and allowed successful cancer treatment without ischemia of the lower limbs.

Abstract 312: Anatomic Runoff Score Predicts Cardiovascular Outcomes in Patients with Lower Extremity Peripheral Artery Disease

2014 ◽  
Vol 7 (suppl_1) ◽  
Author(s):  
William S Jones ◽  
Manesh R Patel ◽  
Thomas T Tsai ◽  
Alan S Go ◽  
Rajan Gupta ◽  
...  
Keyword(s):  
Lower Extremity ◽  
Clinical Outcomes ◽  
Peripheral Artery Disease ◽  
Clinical Decision Making ◽  
Clinical Care ◽  
Composite Endpoint ◽  
P Value ◽  
Peripheral Artery ◽  
Cardiovascular Morbidity And Mortality ◽  
Artery Disease

Background: Although the presence, extent, and severity of obstruction in patients with lower extremity peripheral artery disease (LE-PAD) affect their clinical care, it is not known if these factors are associated with future cardiovascular endpoints. We empirically created an anatomic runoff score (ARS) that was based on the severity of stenosis of each lower extremity segment, and determined its association with clinical outcomes. Methods: We evaluated 908 patients with LE-PAD and bilateral angiography undergoing endovascular or surgical revascularization in a community based clinical study from 2005-2011. Clinical outcomes of interest were 1) all-cause death, 2) myocardial infarction (MI), 3) stroke, and 4) composite of all-cause death, MI, and stroke. Cox proportional hazards models were created and hazard ratios estimated for a standard deviation increment for continuous variables. Results: A total of 260 patients reached the composite endpoint (45 MI, 63 stroke, 152 death) during the study period. ARS ranged from 0-15 [Mean 4.7 (SD 2.5), Figure]. Patients who experienced the composite endpoint were more likely to be older, have more co-morbid conditions, were more likely to have undergone revascularization for CLI, and had a higher ARS (indicating more extensive PAD). The most significant predictors of the composite endpoint (death/MI/stroke) were age (delta=10 years; HR 1.40, CI 1.25-1.55, p<0.0001), diabetes mellitus (HR 1.51, CI 1.16-1.98, p=0.0026), ARS (delta=2 points; HR 1.15, CI 1.03-1.26, p=0.0187), and indication for procedure (CLI vs. claudication; HR 1.68, CI 1.28-2.21, p=0.0002). The use of the ARS to predict the composite outcome was comparable for patients with CLI and patients with claudication (in patients with CLI, ARS HR=1.15; in patients with Claudication, ARS HR=1.21; interaction p value=0.70). Conclusions: After adjustment for clinical factors, the LE-PAD anatomic runoff score, age and indication for procedure were the most significant predictors of future cardiovascular morbidity and mortality in a broadly-representative patient population undergoing revascularization for symptomatic PAD. The use of a clinically useful anatomic scoring system, if validated, may assist clinicians in risk-stratifying patients during the course of clinical decision-making.

International public awareness of peripheral artery disease

VASA ◽  
2021 ◽  
pp. 1-7
Author(s):  
Rupert Bauersachs ◽  
Marianne Brodmann ◽  
Christopher Clark ◽  
Sebastian Debus ◽  
Marco De Carlo ◽  
...  
Keyword(s):  
Peripheral Artery Disease ◽  
Public Awareness ◽  
Age Groups ◽  
Lower Limbs ◽  
Common Condition ◽  
Peripheral Artery ◽  
Health And Disease ◽  
Artery Disease ◽  
Gender Based ◽  
Delays In Diagnosis

Summary: Background: Peripheral artery disease (PAD) of the lower limbs is a common condition with considerable global burden. Some country-specific studies suggest low levels of public awareness. To our knowledge public awareness of PAD has never been assessed simultaneously in several countries worldwide. Patients and methods: This was an international, general public, internet-based quantitative survey assessing vascular health and disease understanding. Questionnaires included 23 closed-ended multiple-choice, Likert scale and binary choice questions. Data were collected from 9,098 survey respondents from nine countries in Europe, North and Latin America during May-June 2018. Results: Overall, familiarity with PAD was low (57% of respondents were “not at all familiar”, and 9% were “moderately” or “very familiar”). Knowledge about PAD health consequences was limited, with 55% of all respondents not being aware of limb consequences of PAD. There were disparities in PAD familiarity levels between countries; highest levels of self-reported awareness were in Germany and Poland where 13% reported to be “very” or “moderately” familiar with PAD, and lowest in Scandinavian countries (5%, 3% and 2% of respondents in Norway, Sweden and Denmark, respectively). There were disparities in awareness according to age. Respondents aged 25–34 were most familiar with PAD, with 12% stating that they were “moderately” or “very” familiar with the condition, whereas those aged 18–24 were the least familiar with PAD (7% “moderately” or “very” familiar with PAD). In the 45–54, 55–64 and 65+ age groups, 9% said they were “moderately” or “very” familiar with the term. There was no important gender-based difference in PAD familiarity. Conclusions: On an international level, public self-reported PAD awareness is low, even though PAD is a common condition with considerable burden. Campaigns to increase PAD awareness are needed to reduce delays in diagnosis and to motivate people to control PAD risk factors.

Epidemiology of Peripheral Artery Disease and Polyvascular Disease

2021 ◽  
Vol 128 (12) ◽  
pp. 1818-1832
Author(s):  
Aaron W. Aday ◽  
Kunihiro Matsushita
Keyword(s):  
Risk Factors ◽  
Cardiovascular Disease ◽  
Coronary Artery Disease ◽  
Peripheral Artery Disease ◽  
Microvascular Disease ◽  
Adverse Outcomes ◽  
Peripheral Artery ◽  
Cardiovascular Morbidity And Mortality ◽  
Increase Risk ◽  
Artery Disease

Atherosclerotic lower extremity peripheral artery disease (PAD) is increasingly recognized as an important cause of cardiovascular morbidity and mortality that affects >230 million people worldwide. Traditional cardiovascular risk factors, including advanced age, smoking, and diabetes, are strongly linked to an increase risk of PAD. Although PAD has been historically underappreciated compared with coronary artery disease and stroke, greater attention on PAD in recent years has led to important new epidemiological insights in the areas of thrombosis, inflammation, dyslipidemia, and microvascular disease. In addition, the concept of polyvascular disease, or clinically evident atherosclerosis in multiple arterial beds, is increasingly identified as a particularly malignant cardiovascular disease worthy of special clinical attention and further study. It is noteworthy that PAD may increase the risk of adverse outcomes in similar or even greater magnitude than coronary disease or stroke. In this review, we highlight important new advances in the epidemiology of PAD with a particular focus on polyvascular disease, emerging biomarkers, and differential risk pathways for PAD compared with other atherosclerotic diseases.

scholarly journals Gender Differences in the Medical Treatment of Peripheral Artery Disease

2021 ◽  
Vol 10 (13) ◽  
pp. 2855
Author(s):  
Damien Lanéelle ◽  
Gabriella Sauvet ◽  
Jérôme Guillaumat ◽  
Jean Eudes Trihan ◽  
Guillaume Mahé
Keyword(s):  
Peripheral Arterial Disease ◽  
Medical Treatment ◽  
Peripheral Artery Disease ◽  
Severe Disease ◽  
Arterial Disease ◽  
Peripheral Artery ◽  
Primary Health ◽  
Cardiovascular Morbidity And Mortality ◽  
Artery Disease ◽  
Peripheral Arterial

Background/Objectives: Peripheral arterial disease is a frequent and severe disease with high cardiovascular morbidity and mortality. However, female patients appear to be undertreated. Objectives: The primary goal was to compare the prescription of optimal medical treatment (OMT) of peripheral arterial disease between women and men in primary health care. Material and methods: An observational retrospective study was based on the data collected from general practitioners (GP) office in Brittany. Results: The study included 100 patients, aged 71 ± 10 years old, with 24% of women. Compared to men, women received the OMT less frequently (29.2% vs. 53.9%, p = 0.038), especially after 75 years old. Antiplatelet therapy was largely prescribed (100%), statins less frequently (70.8% women vs. 85.5% men), and prescription of renin-angiotensin-aldosterone system inhibitors was still not optimal in the two genders (41.7% women vs. 61.9% men). Active smoking is important for both women and men (33% and 30% respectively). Conclusion: Optimal medical treatment of peripheral artery disease is insufficiently prescribed, especially in women in this region of France.

Sign in / Sign up

Export Citation Format

Share Document