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Cardio Diabetes Medicine 2017 87

Peripheral Vascular Disease

Dr. J. Ezhilan, MD, DM, DNB, FNB, FSCAI.
Senior Consultant Interventional Cardiologist
Madras Medical Mission- Chennai

ABSTRACT EPIDEMIOLOGY
Peripheral arterial disease (PAD) affects 12% of adult Peripheral arterial disease (PAD) of the lower limbs
population and both male and female are equally af- affects approximately 12% of the adult population.
fected. PAD is always associated with Coronary ar- At younger age, PAD is more prevalent in men than
tery disease and cerebral vascular disease hence it women; however, with advancing age, gender distri-
leads to increase risk of myocardial infarction, stroke bution is equal . PAD is always associated with cor-
1
and death. Through history taking and physical ex- onary artery disease and cerebrovascular disease
amination complimented by a array of non invasive in 38% of the population. Patients with PAD have a
testing can lead to early diagnosis of PAD which is higher rate of all cause mortality and are at increased
usually diagnosed late or missed. Medical manage- risk of cardio vascular events, including myocardial
ment of PAD is primary risk factor optimization like infarction, stroke and cardiovascular death. In India,
smoking cessation, good control of diabetes mellitus, around 10 million people are affected with PAD of the
optimum blood pressure levels in systemic hyperten- lower limbs. The 5-year rate of non-fatal cardiovascu-
sion and satin therapy. For atypical symptoms and lar events among patients with symptomatic PAD is
mild to moderate claudication exercise therapy and 20% and the mortality ranges from 15 to 30%. Major
pharmaco therapy is sufficient. For severe claudica- risk factors for PAD are increasing age, current or
tion, chronic limb ischemia and acute limb ischemia, past tobacco use, and the presence of diabetes, dys-
endovascular interventions and surgical bypass are lipidemia, hypertension and chronic kidney disease.
done. The field of interventional cardiology in PAD Of these risk factors, smoking and diabetes pose the
has been rapidly expanding in the last decade with greatest risk for the development and progression
a wide array of new devices that has made endo- of PAD.
vascular interventions much safer and is now slowly
replacing surgical Bypass. CLINICAL FEATURES OF PAD

A thorough history taking and physical examination
is the first step in diagnosing PAD. Majority of the
patients (30 to 50%) with PAD are asymptomatic and
although patients do not have symptoms with their
activities of daily living, they may have functional
impairment of formal testing. Atypical symptoms of
PAD include lower extremity discomfort or fatigue
that begins during exertion but is not reproducible
with the same level of exertion and may require a
longer period of time to resolve. Claudication, the
classical symptom of PAD includes pain, discom-
The peripheral arterial system includes all non-cardiac arteries: the fort and heaviness, tiredness, cramping and burning
thoracic and abdominal aorta and their branches extending to vis- sensation in the muscles of the calf, hip, thigh or
ceral organs and both upper and lower extremities as well as the
extra cranial vessels Fig.1. buttocks, which is reproducible with a similar level of

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