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Peripheral artery disease: Difference between revisions
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(Created page with "'''Peripheral artery disease''' (PAD) is the manifestation of atherosclerosis of the peripheral arteries supplying the legs and feet. Atherosclerosis diminishes perfusion of the legs and feet, in most cases only during activity, but in severe cases even in rest. As an atherosclerotic disease, it mostly co-exists with other atherosclerotic diseases like coronary artery disease and cerebrovascular disease. Peripheral artery disease is a disease of elderly smoke...") |
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'''Peripheral artery disease''' (PAD) is the manifestation of [[atherosclerosis]] of the peripheral arteries supplying the legs and feet. Atherosclerosis diminishes perfusion of the legs and feet, in most cases only during activity, but in severe cases even in rest. As an atherosclerotic disease, it mostly co-exists with other atherosclerotic diseases like [[coronary artery disease]] and [[cerebrovascular disease]]. Peripheral artery disease is a disease of elderly smokers. | <section begin="dermatology" />'''Peripheral artery disease''' (PAD) is the manifestation of [[atherosclerosis]] of the peripheral arteries supplying the legs and feet. Atherosclerosis diminishes perfusion of the legs and feet, in most cases only during activity, but in severe cases even in rest. As an atherosclerotic disease, it mostly co-exists with other atherosclerotic diseases like [[coronary artery disease]] and [[cerebrovascular disease]]. Peripheral artery disease is a disease of elderly smokers.<section end="dermatology" /> | ||
== Etiology == | == Etiology == | ||
Risk factors are the same as for [[atherosclerosis]] in general, including [[smoking]], [[hypertension]], [[dyslipidaemia]], and [[diabetes mellitus]]. | Risk factors are the same as for [[atherosclerosis]] in general, including [[smoking]], [[hypertension]], [[dyslipidaemia]], and [[diabetes mellitus]]. | ||
<section begin="dermatology" /> | |||
== Clinical features == | == Clinical features == | ||
Peripheral artery disease classically presents with intermittent claudication. This is a crampy pain which occurs after physical activity like walking, and which resolves after rest. The condition is sometimes called “window shopper’s disease” as people stop walking after a while before resting, often pretending to stop to look at products in shop windows. | <section end="dermatology" />Peripheral artery disease classically presents with intermittent claudication. This is a crampy pain which occurs after physical activity like walking, and which resolves after rest. The condition is sometimes called “window shopper’s disease” as people stop walking after a while before resting, often pretending to stop to look at products in shop windows. | ||
Skin affected by ischaemia is cold and thin, may be “shiny”, has decreased hair growth, decreased nail growth, and shows muscle atrophy. Ischaemia severely impairs wound healing properties, and accidental injuries to ischaemic areas may heal slowly or not at all. | Skin affected by ischaemia is cold and thin, may be “shiny”, has decreased hair growth, decreased nail growth, and shows muscle atrophy. Ischaemia severely impairs wound healing properties, and accidental injuries to ischaemic areas may heal slowly or not at all. | ||
In severe cases (Fontaine stage III and IV), ischaemia in rest is severe enough to cause pain in rest, ulcers, gangrene, or necrosis. These are indicative of ''critical limb ischaemia'', which need urgent treatment. | <section begin="dermatology" />In severe cases (Fontaine stage III and IV), ischaemia in rest is severe enough to cause pain in rest, ulcers, gangrene, or necrosis. These are indicative of ''critical limb ischaemia'', which need urgent treatment. | ||
<section end="dermatology" /> | |||
=== Locations === | === Locations === | ||
The location of the symptoms depends on the location of the atherosclerotic narrowing: | The location of the symptoms depends on the location of the atherosclerotic narrowing: | ||
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* Popliteal artery – Affection of lower 1/3 of calf | * Popliteal artery – Affection of lower 1/3 of calf | ||
* Tibial or peroneal artery – Affection of foot | * Tibial or peroneal artery – Affection of foot | ||
<section begin="dermatology" /> | |||
== Fontaine classification == | == Fontaine classification == | ||
The Fontaine classification classifies PAD according to the severity of the symptoms: | The Fontaine classification classifies PAD according to the severity of the symptoms: | ||
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Measurement of the [[ankle-brachial index]] or [[toe-brachial index]] is essential and gives a good objective measurement of lower limb perfusion. | Measurement of the [[ankle-brachial index]] or [[toe-brachial index]] is essential and gives a good objective measurement of lower limb perfusion. | ||
The diagnosis of Fontaine stage I – II can be made clinically based on the presence of typical risk factors and clinical features. | The diagnosis of Fontaine stage I – II can be made clinically based on the presence of typical risk factors and clinical features.<section end="dermatology" /> | ||
Imaging is used in severe cases for preoperative planning. Doppler [[ultrasonography]] and [[angiography]] are used, either <abbr>[[DSA]]</abbr> or [[CT]] or [[MR]] angiography. | Imaging is used in severe cases for preoperative planning. Doppler [[ultrasonography]] and [[angiography]] are used, either <abbr>[[DSA]]</abbr> or [[CT]] or [[MR]] angiography. | ||
<section begin="dermatology" /> | |||
== Treatment == | == Treatment == | ||
Treatment involves lifestyle changes, exercise, medical treatment, as well as revascularisation procedures in severe cases. [[Smoking]] cessation is especially obligatory, as the disease will progress regardless of measures taken as long as smoking continues. | Treatment involves lifestyle changes, exercise, medical treatment, as well as revascularisation procedures in severe cases. [[Smoking]] cessation is especially obligatory, as the disease will progress regardless of measures taken as long as smoking continues. | ||
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=== Surgical treatment === | === Surgical treatment === | ||
Surgical treatment involves endovascular and/or open surgery. It is indicated if the patient has severe symptoms which don’t improve after conservative treatment, or if the patient has Fontaine stage III or IV PAD. Critical limb ischaemia must be treated urgently to prevent loss of limbs. | Surgical treatment involves endovascular and/or open surgery. It is indicated if the patient has severe symptoms which don’t improve after conservative treatment, or if the patient has Fontaine stage III or IV PAD. Critical limb ischaemia must be treated urgently to prevent loss of limbs.<section end="dermatology" /> | ||
Endovascular procedures include balloon angioplasty, stenting, and/or atherectomy (“shaving” off atherosclerotic plaques). Open surgical procedures involve bypassing the occlusion with the great saphenous vein or artificial prosthesis. Hybrid procedures combine both endovascular and open surgical techniques. | Endovascular procedures include balloon angioplasty, stenting, and/or atherectomy (“shaving” off atherosclerotic plaques). Open surgical procedures involve bypassing the occlusion with the great saphenous vein or artificial prosthesis. Hybrid procedures combine both endovascular and open surgical techniques. | ||