Introduction to peripheral artery disease
Atherosclerosis affecting the lower-extremity arteries is termed peripheral artery disease (PAD). PAD affects about 10% of Australian adults, and more than 20% of patients older than 75 yearsAitken, 2020Conte, 2018. Patients with PAD can experience no symptoms, have typical intermittent claudication or develop critical limb-threatening ischaemia. Irrespective of the clinical features, patients with PAD are at high absolute atherosclerotic cardiovascular disease risk; major adverse cardiovascular events are common and aggressive management of atherosclerotic risk factors is important.
The risk factors for the development of PAD are similar to those for atherosclerosis at other sites.
Independent modifiable risk factors for the development of PAD include:
Smoking (including passive) and diabetes confer the greatest risk of developing PADChuter, 2021.
Nonmodifiable risk factors for the development of PAD include advanced age, male sex and non-Caucasian race.
Patients with PAD often have atherosclerosis in other vascular territories. The presence of coexistent coronary artery or cerebrovascular disease is referred to as polyvascular disease and confers a worse prognosis; the absolute benefit of risk factor modification is greatest in these patients. Follow the principles for reducing atherosclerotic risk outlined in Atherosclerotic cardiovascular disease risk estimation.
Patients with PAD also have an increased noncardiovascular (eg cancer) mortality. Actively manage intercurrent illnesses and investigate for suspected cancer.