Peripheral artery disease (PAD) is an important aspect of the atherosclerotic cardiovascular disease continuum and causes significant morbidity and mortality worldwide in millions of people (20 millions alone in Europe!).
PAD is a strongly age-dependent condition and the prevalence sharply increases after the age of 50 with high association with coronary artery disease (CAD) (33-85 %) and cerebrovascular disease (CVD) (25-60 %). Even asymptomatic PAD is a powerful independent predictor of mortality from CAD and CVD. Risk factors are similar with CAD and CVD and diabetes plays a major role in the development of small vessel disease.
History and physical examination are of great importance in the diagnosis, although may not be conclusive in 50 % of patients who are mainly asymptomatic. ABI is the key diagnostic measure with high sensitivity and specificity (1.0-1.4 normal, 0.7-0.9 mild to moderate Pad,0.4-0.69 moderate to severe PAD,<0.4 severe PAD).
Low ABI is associated with bad prognosis.Segmental limb pressure assessment is also useful. Dupplex USG,MRI and CT are other key non-invasive diagnostic tools. Percutaneous interventions are the treatment of choice with very good results by different approaches and replaced surgery in the vast majority of patients. Data for use of drug eluting stents in PAD is limited.