Peripheral arterial disease natural history, complications and prognosis
Editors-in-Chief: C. Michael Gibson, M.D., Beth Israel Deaconess Medical Center, Boston, MA; Robert G. Schwartz, M.D. [1], Piedmont Physical Medicine and Rehabilitation, P.A.; Associate Editor-In-Chief: Cafer Zorkun, M.D., Ph.D. [2]
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Overview
Natural History
- An accurate history is the key to the diagnosis of PAD
- Eliciting atherosclerotic risk factors in the history may help to identify patients, who although asymptomatic, have evidence of PAD on physical examination or noninvasive testing.
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