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Peripheral Arterial Disease

Peripheral Arterial Disease is a topic covered in the 5-Minute Clinical Consult.

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Peripheral arterial disease (PAD) is defined as atherosclerotic occlusive disease of the peripheral arteries, most commonly in the lower extremities. Following coronary artery disease and cerebrovascular disease, PAD is the third leading source of atherosclerotic vascular morbidity. PAD manifests as intermittent claudication (IC) or atypical leg pain and is commonly diagnosed with a resting ankle-brachial index (ABI) of <0.90.


  • Age: >50 years
  • Sex: male > female (2:1)
  • Impacts at least 8 million people in the United States
  • Globally, an estimated >200 million people have PAD with increased prevalence in low- and middle-income countries.

  • Annual incidence is 7.1/1,000 men and 3.6/1,000 women among all ages, per Framingham Heart Study.
  • Incidence increases with age and the presence of cardiovascular risk factors.
  • U.S. prevalence: 5.9% in adults >40
  • Prevalence approaches 30% in high-risk populations.
  • Higher prevalence and severity in African Americans and Hispanics

Etiology and Pathophysiology

  • In PAD, arterial occlusion most commonly occurs secondary to atherosclerotic disease.
  • Other etiologies include phlebitis, trauma, or autoimmune/vasculitic diseases.
  • Arterial narrowing impairs the ability to adequately oxygenate muscle during periods of increased demand (i.e., exercise), causing claudication and exercise limitation.
  • Reperfusion at rest following ischemia can result in multiple subsequent physiologic changes, including inflammation, oxidant stress, endothelial dysfunction, and mitochondrial injury.

Although several of the risk factors for PAD (as noted below) are heritable, genome-wide association studies isolating PAD-specific single nucleotide polymorphisms have not been as successful. This has been attributed to the increased clinical and genetic heterogeneity of PAD.

Risk Factors

  • Age >50 years
  • Cigarette smoking
  • Diabetes mellitus (DM)
  • Obesity
  • Hypertension
  • Hyperlipidemia
  • Chronic kidney disease (CKD)
  • Hyperviscosity
  • Heritable conditions: chylomicronemia, hypercholesterolemia, hyperhomocysteinemia, and pseudoxanthoma elasticum

General Prevention

  • Regular aerobic exercise program
  • Smoking cessation
  • Blood pressure (BP) and diabetes control
  • Statin therapy is indicated in those with clinical PAD for secondary prevention of atherosclerotic cardiovascular disease.

Commonly Associated Conditions

In addition to the aforementioned risk factors, PAD is associated with other forms of atherosclerotic disease including myocardial infarction (MI), transient ischemic attack (TIA), and cerebrovascular accident (CVA).

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Stephens, Mark B., et al., editors. "Peripheral Arterial Disease." 5-Minute Clinical Consult, 27th ed., Wolters Kluwer, 2019. Medicine Central, im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/116918/all/Peripheral_Arterial_Disease.
Peripheral Arterial Disease. In: Stephens MB, Golding J, Baldor RA, et al, eds. 5-Minute Clinical Consult. 27th ed. Wolters Kluwer; 2019. https://im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/116918/all/Peripheral_Arterial_Disease. Accessed April 18, 2019.
Peripheral Arterial Disease. (2019). In Stephens, M. B., Golding, J., Baldor, R. A., & Domino, F. J. (Eds.), 5-Minute Clinical Consult. Available from https://im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/116918/all/Peripheral_Arterial_Disease
Peripheral Arterial Disease [Internet]. In: Stephens MB, Golding J, Baldor RA, Domino FJ, editors. 5-Minute Clinical Consult. Wolters Kluwer; 2019. [cited 2019 April 18]. Available from: https://im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/116918/all/Peripheral_Arterial_Disease.
* Article titles in AMA citation format should be in sentence-case
TY - ELEC T1 - Peripheral Arterial Disease ID - 116918 ED - Stephens,Mark B, ED - Golding,Jeremy, ED - Baldor,Robert A, ED - Domino,Frank J, BT - 5-Minute Clinical Consult, Updating UR - https://im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/116918/all/Peripheral_Arterial_Disease PB - Wolters Kluwer ET - 27 DB - Medicine Central DP - Unbound Medicine ER -