5 Markers of inflammation and thrombosis, elevated lipoprotein(a) and homocysteine levels, and chronic kidney disease are also associated with peripheral artery disease. The risk factors for peripheral artery disease are similar to those for other atherosclerotic vascular diseases, with smoking and diabetes mellitus being the strongest. The total annual costs associated with the hospitalization of patients with peripheral artery disease in the United States are estimated to be in excess of $21 billion, 6 a number that is projected to rise as the population ages. On the basis of the prevalence in cohort studies of an abnormal ankle–brachial index - the ratio of the systolic blood pressure at the ankle to the systolic blood pressure in the arm 3 - it is estimated that at least 8.5 million persons in the United States 4 and more than 200 million people worldwide 5 have peripheral artery disease. Revascularization, endovascular or surgical, is indicated for symptoms that persist despite medical management or for limb salvage in the context of critical limb ischemia. Computed tomography or magnetic resonance angiography can also be useful in planning for revascularization.
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Cilostazol can be used as an adjunct to an exercise program.Ĭonventional angiography is typically performed when revascularization is being considered. Supervised exercise increases walking distance. In the treatment of peripheral artery disease, the main goals are to reduce cardiovascular risk and improve functional capacity. Exercise testing can uncover mild disease and quantify functional capacity. Noninvasive vascular testing provides information on the presence, severity, and location of peripheral artery disease. Smoking and diabetes are the strongest risk factors. Key Clinical Points Peripheral Artery DiseaseĪtherosclerotic peripheral artery disease affects more than 200 million persons worldwide, including at least 8.5 million persons in the United States, and is associated with high rates of cardiovascular events and death. How would you evaluate and manage this case? The Clinical Problem On examination, the blood pressure is 126/82 mm Hg, there is a bruit over the right femoral artery, and pulses are diminished in the right leg. She has a smoking history of 50 pack-years and currently smokes eight cigarettes per day. Her medical history is notable for coronary-artery bypass surgery after a myocardial infarction at 55 years of age and for hyperlipidemia, for which she takes atorvastatin at a dose of 40 mg daily. She is able to walk no more than 50 m before having to stop because of leg pain. Her symptoms have recently progressed to involve the right calf. The article ends with the authors’ clinical recommendations.Ī 61-year-old woman presents with a 3-year history of discomfort in the right thigh on exertion. Evidence supporting various strategies is then presented, followed by a review of formal guidelines, when they exist. This Journal feature begins with a case vignette highlighting a common clinical problem.
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