10 steps before you refer for peripheral arterial disease

Br J Cardiol 2009;16:288-91 Leave a comment
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Peripheral arterial disease (PAD) is a condition that is frequently underdiagnosed and often the subject of suboptimal care. It can present with rest pain or gangrene (critical ischaemia), but this is not common. Intermittent claudication (IC), leg pain on walking, is its most common manifestation. Leg pain on walking is a presentation commonly seen in general practice, and has several potential causes other than PAD. IC has been shown to affect 4.5% of subjects between the ages of 45 and 65 years and is a marker for increased cardiovascular risk.1 In respect of the leg itself, IC is a relatively benign condition with most patients improving or stabilising and fewer than 5% progressing to major amputation. However, patients with IC are at increased risk of death, especially due to vascular events in the coronary and cerebral territories.2 PAD is caused by the occlusion or narrowing of large peripheral arteries, usually from atherosclerosis, and, as such, it shares all the major risk factors that can lead to myocardial infarction (MI) or stroke. Most patients with PAD will also have disease (either symptomatic or asymptomatic) in their coronary and cerebral circulation, and MI and stroke are common causes of death in patients with PAD. Vigilance for the condition will provide opportunities to reduce cardiovascular risk in a group who are high risk. Accurate diagnosis and assessment will reveal those who would most benefit from specialist intervention.

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