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Epidemiology, risk factors, and natural history of peripheral artery disease

Linda Harris, MD, FACS
Maciej Dryjski, MD, PhD, FACS
Section Editors
Joseph L Mills, Sr, MD
John F Eidt, MD
Deputy Editor
Kathryn A Collins, MD, PhD, FACS


Atherosclerosis is a systemic disease of the large and medium-sized arteries causing luminal narrowing (focal or diffuse) as a result of the accumulation of lipid and fibrous material between the intimal and medial layers of the vessel. Atherosclerosis of the noncardiac vessels is defined as peripheral artery disease (PAD). An ankle-brachial index (ABI) ≤0.90 is sensitive and specific for arterial stenosis/occlusion and diagnostic for PAD [1].

Although other disease processes can lead to narrowing of the arteries (eg, inflammation, thrombosis) and symptoms of arterial insufficiency, PAD is by far the most prevalent etiology. The lower extremity vessels are affected more commonly than the upper extremity vessels.

Ischemic symptoms result when there is an imbalance between the supply and demand for blood flow. The clinical manifestations of PAD depend upon the location and severity of arterial stenosis or occlusion, and range from mild extremity pain with activity (ie, claudication) to limb-threatening ischemia. For patients found to have asymptomatic PAD, the natural history is relatively benign; however, for those patients with PAD who continue to smoke or have diabetes or renal insufficiency, the clinical manifestations can progress rapidly and unpredictably.

The epidemiology, risk factors, and natural history of peripheral artery disease are reviewed here. The clinical manifestations and management of peripheral artery disease are discussed elsewhere. (See "Clinical features and diagnosis of lower extremity peripheral artery disease" and "Management of claudication".)


The worldwide prevalence of lower extremity peripheral artery disease (PAD) is between 3 and 12 percent [2-8]. In 2010, 202 million people around the world were living with PAD [9]. In Europe and North America, an estimated 27 million individuals are affected with approximately 413,000 inpatient admissions annually attributed to PAD [2]. The majority of individuals with PAD (70 percent) live in low/middle income regions of the world, including 55 million individuals in southeast Asia and 46 million in the western pacific region [9]. The number of individuals with PAD increased by 29 percent in low/middle income regions and 13 percent in high income regions from 2000 to 2010 compared with the preceding decade [9].

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