Peripheral artery disease

peripheral vascular diseaseperipheral arterial diseasearterial insufficiencyperipheral artery occlusive diseaseperipheral vascular diseasescirculation problems in his legsperipheral arterial occlusive diseasePeripheral Vascular Surgeonacute leg ischemiaarterial occlusive disease
Peripheral artery disease (PAD) is an abnormal narrowing of arteries other than those that supply the heart or brain.wikipedia
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Intermittent claudication

claudication intermittensvascular claudication
The classic symptom is leg pain when walking which resolves with rest, known as intermittent claudication.
It is classically associated with early-stage peripheral artery disease, and can progress to critical limb ischemia unless treated or risk factors are modified.

Arterial insufficiency ulcer

Arterial ulcersarterialarterial insufficiency ulcers
Other symptoms include skin ulcers, bluish skin, cold skin, or abnormal nail and hair growth in the affected leg. Other complications of severe PAD include lower limb tissue loss, arterial insufficiency ulcers, erectile dysfunction, and gangrene.
They are commonly caused by peripheral artery disease (PAD).

Gangrene

gangrenousfesteringdry gangrene
Complications may include an infection or tissue death which may require amputation; coronary artery disease, or stroke. Other complications of severe PAD include lower limb tissue loss, arterial insufficiency ulcers, erectile dysfunction, and gangrene.
Risk factors include diabetes, peripheral arterial disease, smoking, major trauma, alcoholism, HIV/AIDS, frostbite, and Raynaud's syndrome.

Hypertension

high blood pressurehypertensivearterial hypertension
Other risk factors include diabetes, high blood pressure, kidney problems, and high blood cholesterol.
Long-term high blood pressure, however, is a major risk factor for coronary artery disease, stroke, heart failure, atrial fibrillation, peripheral vascular disease, vision loss, chronic kidney disease, and dementia.

Atherosclerosis

atheroscleroticatherogenesisatherosclerotic plaques
The most common underlying mechanism of peripheral artery disease is atherosclerosis, especially in individuals over 40 years old.
When severe, it can result in coronary artery disease, stroke, peripheral artery disease, or kidney problems, depending on which arteries are affected.

Diabetes mellitus

diabetesdiabeticdiabetics
Other risk factors include diabetes, high blood pressure, kidney problems, and high blood cholesterol.
Other macrovascular diseases include stroke, and peripheral artery disease.

Cilostazol

Medications, including statins, ACE inhibitors, and cilostazol may also help.
Cilostazol is a quinolinone-derivative medication used in the alleviation of the symptoms of intermittent claudication in individuals with peripheral vascular disease.

Blood pressure

systolic blood pressurediastolic blood pressurearterial blood pressure
PAD is typically diagnosed by finding an ankle-brachial index (ABI) less than 0.90, which is the systolic blood pressure at the ankle divided by the systolic blood pressure of the arm.
However, occasionally there is a consistent difference greater than 10 mmHg which may need further investigation, e.g. for peripheral arterial disease or obstructive arterial disease.

Critical limb ischemia

tissue losscritical limb ischaemiaischemic limb
In individuals with severe PAD complications may arise, including critical limb ischemia and tissue death. Other complications of severe PAD include lower limb tissue loss, arterial insufficiency ulcers, erectile dysfunction, and gangrene.
Critical limb ischemia (CLI), also referred to as limb threat, is an advanced stage of peripheral artery disease (PAD).

Atherectomy

rotablator
Procedures used to treat the disease include bypass grafting, angioplasty, and atherectomy.
It is an alternative to angioplasty for the treatment of peripheral artery disease, but the studies that exist are not adequate to determine if it is superior to angioplasty.

Angioplasty

balloon angioplastyangioplastiespercutaneous transluminal angioplasty
Procedures used to treat the disease include bypass grafting, angioplasty, and atherectomy.
It is most commonly done to treat atherosclerotic narrowings of the abdomen, leg and renal arteries caused by peripheral artery disease.

Cyanosis

cyanoticbluish skinBlue discoloration of the skin
Other symptoms include skin ulcers, bluish skin, cold skin, or abnormal nail and hair growth in the affected leg.
Arterial obstruction (e.g. peripheral vascular disease, Raynaud phenomenon)

Framingham Risk Score

cardiovascular risk factorsFramingham Stroke Risk Score
All people with a Framingham risk score of 10%-20%
In order to assess the 10-year cardiovascular disease risk, cerebrovascular events, peripheral artery disease and heart failure were subsequently added as disease outcomes for the 2008 Framingham Risk Score, on top of coronary heart disease.

Ankle–brachial pressure index

ankle brachial pressure indexankle-brachial indexABPI
PAD is typically diagnosed by finding an ankle-brachial index (ABI) less than 0.90, which is the systolic blood pressure at the ankle divided by the systolic blood pressure of the arm.
Compared to the arm, lower blood pressure in the leg suggests blocked arteries due to peripheral artery disease (PAD).

Pentoxifylline

pentoxyfyllineoxpentifyllinePentoxifylline (PTX)
Pentoxifylline is of unclear benefit.
Pentoxifylline, also known as oxpentifylline, is a xanthine derivative used as a drug to treat muscle pain in people with peripheral artery disease.

Erectile dysfunction

impotenceimpotentimpotency
Other complications of severe PAD include lower limb tissue loss, arterial insufficiency ulcers, erectile dysfunction, and gangrene.
ED is also related to generally poor physical health, poor dietary habits, obesity, and most specifically cardiovascular disease, such as coronary artery disease and peripheral vascular disease.

Vascular bypass

vascular graftArtificial vascular graftsbypass surgery
Vascular bypass grafting can be performed to circumvent a diseased area of the arterial vasculature. The great saphenous vein is used as a conduit if available, although artificial (Gore-Tex or PTFE) material is often used for long grafts when adequate venous conduit is unavailable.
Common bypass sites include the heart (coronary artery bypass surgery) to treat coronary artery disease, and the legs, to treat peripheral vascular disease.

Clopidogrel

Management of high cholesterol, and antiplatelet drugs such as aspirin and clopidogrel. Statins reduce clot formation and cholesterol levels, respectively, can help with disease progression, and address the other cardiovascular risks that the affected person is likely to have.
Clopidogrel is used to prevent heart attack and stroke in people who are at high risk of these events, including those with a history of myocardial infarction and other forms of acute coronary syndrome, stroke, and those with peripheral artery disease.

Cholesterol

serum cholesteroldietary cholesterolcholesterol level
High blood cholesterol – Dyslipidemia, which is an abnormally high level of cholesterol or fat in the blood. Dyslipidemia is caused by a high level of a protein called low-density lipoprotein (LDL cholesterol), low levels of high-density lipoprotein (HDL cholesterol), elevation of total cholesterol, and/or high triglyceride levels. This abnormality in blood cholesterol levels have been correlated with accelerated peripheral artery disease. Management of Dyslipidemia by diet, exercise, and/or medication is associated with a major reduction in rates of heart attack and stroke.
This atherosclerotic disease process, over decades, leads to myocardial infarction (heart attack), stroke, and peripheral vascular disease.

Ischemia

ischemicischaemiaischaemic
The Fontaine stages, were introduced by René Fontaine in 1954 to define severity of chronic limb ischemia:
The degree and extent of symptoms depend on the size and location of the obstruction, the occurrence of clot fragmentation with embolism to smaller vessels, and the degree of peripheral arterial disease (PAD).

Buerger's test

Buerger's test can check for pallor when the affected limb is in an elevated position. The limb is then moved from elevated to sitting position and is checked for redness, which is called reactive hyperemia. Buerger's test is an assessment of arterial sufficiency, which is the ability of the artery is to supply oxygenated blood to the tissue that it goes to.
Where there is peripheral artery disease the leg will revert to the pink colour more slowly than normal and also pass through the normal pinkness to a red-range colouring (rubor - redness) often known as sunset foot.

Femoral artery

femoralsuperficial femoral arteryfemoral arteries
Other imaging can be performed by angiography, where a catheter is inserted into the common femoral artery and selectively guided to the artery in question.
The femoral artery is susceptible to peripheral arterial disease.

Gene therapy

human genetic engineeringgene therapiesgene
In 2011, pCMV-vegf165 was registered in Russia as the first-in-class gene therapy drug for treatment of PAD, including the advanced stage of critical limb ischemia.
In 2011 Neovasculgen was registered in Russia as the first-in-class gene-therapy drug for treatment of peripheral artery disease, including critical limb ischemia.

Pallor

pale skinpalepale appearance
Buerger's test can check for pallor when the affected limb is in an elevated position. The limb is then moved from elevated to sitting position and is checked for redness, which is called reactive hyperemia. Buerger's test is an assessment of arterial sufficiency, which is the ability of the artery is to supply oxygenated blood to the tissue that it goes to.
Peripheral vascular disease

Angiography

angiogramarteriographyangiographic
Other imaging can be performed by angiography, where a catheter is inserted into the common femoral artery and selectively guided to the artery in question. Duplex ultrasonography and angiography may also be used.
Peripheral artery occlusive disease