Peripheral artery disease

Peripheral arterial disease (PAD) is a very common entity. Its frequent coexistence with other cardiovascular diseases affects its management and prognosis. PAD of the lower extremities is caused by progressive stenosis-obstruction of the arteries. Atherosclerosis is the most frequent cause, and is associated with cardiovascular risk factors (smoking, diabetes mellitus, etc.). The clinical manifestations vary according to the intensity of the blood deficit. The Fontaine (and Rutherford) classifications differentiate progression of the disease into asymptomatic, intermittent claudication, pain at rest and trophic lesions. Medical history (Edinburgh questionnaire), physical examination (palpation of pulses) and ankle/arm index (with/without stress test) enable diagnosis, classification, and indication of medical treatment. Arteriography or computed tomography (CT) is reserved for planning surgical treatment. Medical treatment includes risk factor control, exercise therapy and various drugs. Revascularisation techniques (open and/or endovascular) are indicated in very disabling claudication and critical ischaemia (pain at rest and/or minor trophic lesions). In inoperable cases, cell therapy may be considered. In advanced cases (gangrene) primary amputation is the only option.