Peripheral arterial disease
Alerts and Notices
Synopsis
Symptoms develop when the metabolic demand of tissues is greater than vessels are able to deliver. Most patients with PAD are asymptomatic. In those who develop symptoms, look for extremity pain with activity that is relieved with rest (claudication), limb ischemia with the development of ulcers or gangrenous lesions, or critical acute limb ischemia leading to pallor, pulselessness, paresthesia, and poikilothermia.
Atherosclerosis is a type of arteriosclerosis that can lead to narrowing of blood vessels. When atherosclerotic plaques involve 70%-80% of the luminal diameter, blood flow may become limited, particularly during times of physical exertion and increased demand. Plaque rupture may cause occlusion of coronary vessels or cerebrovascular vessels, leading to ischemia and infarction that present as myocardial infarctions and strokes, respectively.
Codes
ICD10CM:I73.9 – Peripheral vascular disease, unspecified
SNOMEDCT:
399957001 – Peripheral arterial occlusive disease
Look For
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Diagnostic Pearls
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Differential Diagnosis & Pitfalls
- Cervical or lumbar spinal stenosis
- Peripheral neuropathy
- Venous thrombosis
- Osteoarthritis
- Reflex sympathetic dystrophy
- Arterial dissection (see, eg, carotid artery dissection, aortic aneurysm dissection)
- Thromboembolism
- Vasospasm
- Vasculitis (see thromboangiitis obliterans, Kawasaki disease, giant cell arteritis)
Best Tests
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Management Pearls
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Therapy
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Drug Reaction Data
Below is a list of drugs with literature evidence indicating an adverse association with this diagnosis. The list is continually updated through ongoing research and new medication approvals. Click on Citations to sort by number of citations or click on Medication to sort the medications alphabetically.Subscription Required
References
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Last Reviewed:04/23/2019
Last Updated:09/11/2019
Last Updated:09/11/2019
Patient Information for Peripheral arterial disease
Overview
Peripheral arterial disease is a condition where arteries become narrower. This reduces blood flow to your limbs and, as a result, they do not get enough blood. The most common cause of peripheral arterial disease in adults over the age of 40 is atherosclerosis. This summary mostly discusses atherosclerosis.Arteries carry blood through our bodies. Atherosclerosis is the slow buildup of fat and cholesterol inside the arteries. This buildup will eventually harden the arteries and narrow the passageway for blood. The artery may even become blocked.
Atherosclerosis can impair blood flow to different organs and body parts, such as the heart, brain, kidneys, and legs.
Cholesterol plaque buildup causes cardiovascular disease, which can lead to heart attacks and strokes. This can happen in two ways:
- The narrowing of blood vessels limits blood flow, depriving organs of blood
- When plaques break off, or rupture, blood clots can form in the artery and stop blood flow beyond the clot (stroke or heart attack)
Who’s At Risk
Adults are more likely to develop atherosclerosis if they have high blood pressure, high cholesterol, a poor diet, obesity, a low exercise level, exposure to smoke or smoking, or a family history of cardiovascular disease. Other risk factors include childhood cancer treatments, heart transplant surgery, and certain systemic illnesses such as kidney disease, diabetes, human immunodeficiency virus (HIV), and systemic lupus erythematosus (SLE).Children with these risk factors are less likely to have cardiovascular disease at a young age, but may begin early to build up fatty plaque in their arteries.
Signs & Symptoms
Atherosclerosis can be present in the arteries for years without any symptoms. As narrowed arteries slow the flow of blood, you may feel fatigue, heart palpitations, shortness of breath, angina-like chest pain on exertion, leg cramps, or other pain. Other symptoms may be erectile dysfunction, high blood pressure, limping, abdominal pain, ankle or leg pain, and leg edema (water retention), depending on the location of the obstructed arteries.Self-Care Guidelines
Preventing fatty buildup in arteries is the best self-care plan. You can quit smoking, improve your diet with fresh fruits and vegetables, manage your weight, increase your physical activity, and follow your doctor's instructions to manage diabetes, high blood pressure, and high cholesterol.When to Seek Medical Care
Since prevention is key, contact your doctor to help you limit the risk of cardiovascular disease.Get help immediately for life-threatening medical emergencies:
- Chest pain, shortness of breath, and extreme fatigue could be symptoms of heart attack.
- If you have trouble speaking and weakness on one side of your face or body, you could be having a stroke.
- Severe leg pain or circulation problems in your legs could be symptoms of peripheral artery disease.
Treatments
Your health care provider may prescribe cholesterol-lowering and/or blood pressure medication. You may be given a list of recommendations to help you stop smoking, manage your weight, improve your diet, and increase physical activity.Peripheral arterial disease