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Overview of lower extremity peripheral artery disease

Authors
Jeffrey S Berger, MD, MS, FAHA, FACC
Mark G Davies, MD, PhD, MBA, FACS, FACC
Section Editors
Emile R Mohler III, MD
Denis L Clement, MD, PhD
John F Eidt, MD
Joseph L Mills, Sr, MD
Deputy Editor
Kathryn A Collins, MD, PhD, FACS

INTRODUCTION

Atherosclerosis results in the accumulation of lipid and fibrous material between the layers of the arterial wall and causes disease of the coronary, cerebral, and peripheral arteries. Atherosclerotic disease often involves the arteries providing flow to the lower extremities, referred to as lower extremity peripheral artery disease (PAD). Atherosclerosis can lead to acute or chronic symptoms due to embolism from more proximal disease, or due to thrombosis of an artery that has been progressively narrowed.

Management of patients with lower extremity PAD should include medical therapies aimed at reducing the risk for future cardiovascular events related to atherosclerosis, such as myocardial infarction, stroke, and peripheral arterial events. These therapies are also particularly important for reducing the risk of events at the time of intervention (surgical or endovascular), when indicated, and for improving long-term survival.

An overview of atherosclerotic occlusive disease affecting the lower extremities is provided here. Disease affecting the upper extremity is reviewed separately. (See "Overview of upper extremity peripheral artery disease".)

ANATOMY AND PATHOPHYSIOLOGY

The subintimal accumulation of lipid and fibrous material can narrow the vessel lumen, or the plaque can rupture causing embolism. Multiple factors contribute to the pathogenesis of atherosclerosis, including endothelial dysfunction, dyslipidemia, inflammatory and immunologic factors, plaque rupture, and tobacco use. (See "Pathogenesis of atherosclerosis".)

The symptoms related to atherosclerotic narrowing of the aorta or lower extremity arteries depend upon the location and severity of disease. Atherosclerotic disease tends to be well localized and usually occurs in the proximal or midportions of a given arterial bed. Atherosclerotic disease follows anatomic patterns, which also have a bearing on the natural history and progression of disease. Patients with diabetes or with end stage renal disease generally present with more distal disease.

                        

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Literature review current through: Feb 2017. | This topic last updated: Wed Jan 25 00:00:00 GMT+00:00 2017.
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