Peripheral arterial disease natural history, complications and prognosis
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
Most patients with peripheral arterial disease have a benign course, with majority being asymptomatic. However, clinical manifestations may progress rapidly in smokers, and those with diabetes or chronic renal failure.
Natural History
- 20% to 50% of patients with peripheral arterial disease are asymptomatic [1]
- Presence of peripheral arterial disease in a patient corelates strongly with high cardiovascular and cerebrovascular mortality [2]
- Of the patients with symptomatic PAD, 30% to 50% have evidence of coronary artery disease, whereas 15% to 25% have evidence of significant carotid artery stenosis [3]
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% |
References
- ↑ McDermott MM, Guralnik JM, Ferrucci L; et al. (2008). "Asymptomatic peripheral arterial disease is associated with more adverse lower extremity characteristics than intermittent claudication". Circulation. 117 (19): 2484–91. doi:10.1161/CIRCULATIONAHA.107.736108. PMID 18458172. Unknown parameter
|month=ignored (help) - ↑ Dhaliwal G, Mukherjee D (2007). "Peripheral arterial disease: Epidemiology, natural history, diagnosis and treatment". The International Journal of Angiology : Official Publication of the International College of Angiology, Inc. 16 (2): 36–44. PMC 2733014. PMID 22477268.
- ↑ Mendelson G, Aronow WS, Ahn C (1998). "Prevalence of coronary artery disease, atherothrombotic brain infarction, and peripheral arterial disease: associated risk factors in older Hispanics in an academic hospital-based geriatrics practice". Journal of the American Geriatrics Society. 46 (4): 481–3. PMID 9560072. Unknown parameter
|month=ignored (help)