Assessing Vascular Surgery Options In Patients With PAD

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Author(s): 
Lauren A. Fisher, DPM, Hillarie L. Sizemore, DPM, and Khurram H. Khan, DPM

Peripheral arterial disease (PAD) is a very common condition that affects 20 to 30 percent of patients over 50 years of age, equating to an estimated 10 million Americans. As the population ages, the incidence of PAD will likely increase dramatically.1
Intermittent claudication is a symptom among patients with PAD and one can use the presence of these symptoms as a diagnostic tool.2 True claudication is an aching or cramping within the muscles in the involved extremity that is exertion-related, relieved by rest and occurs at a relatively constant walking distance.3 As the disease progresses, symptoms may occur at rest, involve the toes and become worse at night.
Other signs and symptoms of PAD include numbness or weakness of the lower extremity, cold legs and feet, hair loss or changes in skin color, ischemic foot ulcers and erectile dysfunction, which happens to be one of the initial indications of PAD.4
A 2001 study discussed the implications of asymptomatic PAD. The study included findings from a national survey that involved nearly 7,000 patients over the age of 70 and patients over the age of 50 who had a history of smoking or diabetes. Researchers screened patients’ ankle-brachial indices (ABIs) and diagnosed peripheral vascular disease (PVD) in 29 percent of all patients. Forty-four percent of patients with PVD had PVD alone. In addition, PVD was also previously undiagnosed and physicians uncovered it only through use of the ABI, despite no symptoms. Clinicians who rely on the classic symptom (claudication) for diagnosing PAD are likely to miss 85 to 90 percent of the cases.5
Why is this important? In the Coronary Artery Surgery Study (CASS) involving patients with known coronary artery disease (CAD), the presence of PAD increased cardiovascular mortality by 25 percent during a 10-year follow-up.6 Peripheral arterial disease, symptomatic or asymptomatic, is a powerful independent predictor of CAD and coronary vascular disease (CVD).7

Pertinent Diagnostic Pointers

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