Peripheral arterial disease (PAD) is a growing health concern for many Americans. It is often a consequence of systemic disease processes that affect multiple arterial circulations. The burden of the disease typically occurs alongside other cardiovascular risk factors, including diabetes mellitus, (DM), hypertension, smoking and lipid disorders. DM, in particular, is an increasingly important co-factor due to the number of PAD patients with DM continuing to increase. Intermittent claudication (IC), an early manifestation of PAD, more often leads to a reduction in quality of life for patients who are limited in their ambulation. Patients with compromised blood flow to the extremities as a result of PAD may present with typical ischemic pain of one or more muscle groups, atypical pain or no symptoms whatsoever. Arterial occlusion, which causes acute limb ischemia, may also be a life threatening condition associated with PAD.

This paper explores the etiology, risk factors, and clinical manifestations of lower extremity arterial disease. This includes disorders that affect the leg arteries, (PAD), due to atherosclerosis. Through the understanding, of the role of the Acute Care NP in the treatment options and implications for care, the frequency of asymptomatic disease, the noninvasive evaluation and management of this disorder by medical therapy, percutaneous intervention, and surgery will be presented.

Introduction

Atherosclerotic cardiovascular disease is an extremely significant health problem in the United States. Heart and cerebrovascular diseases are leading causes of mortality, and PAD is a leading cause of morbidity in elderly people, due to the significance of this health problem. PAD is the most typical form of peripheral vascular disease. This disease is characterized by a partial or complete failure of the arterial system to deliver oxygenated blood to peripheral tissue. Atherosclerosis is, by far, the most common etiology of PAD. While more common in the lower extremities, lesions and symptoms of PAD may occur in both the upper and the lower extremities of the body.

Epidemiology

PAD and coronary artery disease (CAD) share risk factors. In addition to age and gender, hypercholesterolemia, hypertension, hyperhomocystinemia, diabetes and smoking, are the strongest risk factors for PAD. Gender, increasing age, and smoking conferred a 1.5-fold increased risk for developing intermittent claudication. Diabetes, and stage 2 or greater hypertension, were associated with more than a 2-fold increase in intermittent claudication. Whereas, clinical evidence of coronary artery disease almost tripled the risk of IC. Data from the Framingham Heart Study, revealed that 20% of symptomatic patients with PAD had diabetes.

Pathophysiology

Atherosclerosis is the leading cause of PAD in patients > 40 years of age. Other causes may include thrombosis, embolism, vasculitis, fibromuscular dysplasia, entrapment, cystic adventitial disease, and trauma. It is also important to note that the highest prevalence of atherosclerotic PAD typically occurs during the sixth and seventh decades of life, with an increased risk of developing PAD in cigarette smokers and in persons with diabetes mellitus, hypercholesterolemia, hypertension, or hyperhomocysteinemia. Research shows that PAD is caused by atherosclerosis, which leads to arterial stenosis and occlusions in the major vessels supplying the lower extremities. Patients with intermittent claudication have normal blood flow at rest (and, therefore, have no limb symptoms at rest).