Carman TL, Ang S. Carman T.L., Ang S Carman, Teresa L., and Sik Kim Ang.Peripheral Arterial Disease & Venous Thromboembolism. In: Williams BA, Chang A, Ahalt C, Chen H, Conant R, Landefeld C, Ritchie C, Yukawa M. Williams B.A., Chang A, Ahalt C, Chen H, Conant R, Landefeld C, Ritchie C, Yukawa M Eds. Brie A. Williams, et al.eds. Current Diagnosis & Treatment: Geriatrics, Second Edition New York, NY: McGraw-Hill; 2014. http://accessmedicine.mhmedical.com/content.aspx?bookid=953&sectionid=53375656. Accessed April 20, 2019.
Carman TL, Ang S. Carman T.L., Ang S Carman, Teresa L., and Sik Kim Ang.. "Peripheral Arterial Disease & Venous Thromboembolism." Current Diagnosis & Treatment: Geriatrics, Second Edition Williams BA, Chang A, Ahalt C, Chen H, Conant R, Landefeld C, Ritchie C, Yukawa M. Williams B.A., Chang A, Ahalt C, Chen H, Conant R, Landefeld C, Ritchie C, Yukawa M Eds. Brie A. Williams, et al. New York, NY: McGraw-Hill, 2014, http://accessmedicine.mhmedical.com/content.aspx?bookid=953&sectionid=53375656.
Common symptoms of leg discomfort with ambulation, rest pain, nonhealing ulcers, or gangrene.
Abnormal pulse exam in most patients.
Abnormal ankle-branchial index is diagnostic.
Evidence of systemic atherosclerosis is common.
History of diabetes mellitus, tobacco use, hypertension, or hyperlipidemia may be present.
Peripheral vascular disease broadly defines any vascular disease of the extracranial carotid arteries, the aorta and its branches, and the extremities. However, peripheral arterial disease (PAD) is usually used to refer to atherosclerotic disease of the lower extremities. Atherosclerotic PAD is the most common form of PAD in older adults. But, the differential diagnosis for arterial vascular disease is quite broad (Table 32–1).
Table 32–1. Peripheral arterial disease.
Mycotic aneurysm—syphilis, Salmonella, and multiple other organisms have been reported.
The prevalence of PAD is >10% in individuals older than age 60 years and increases to >25% in people older than 75 years. Although PAD is associated with cardiovascular risk factors, a prevalence of approximately 9% has been documented in patients without traditional risk factors. Nontraditional risk factors, including ethnicity, also influence disease prevalence. Current guidelines call for screening all individuals who are older than age 65 years, patients older than age 50 years with a history of smoking or diabetes, and individuals with suspected PAD, including exertional leg symptoms and nonhealing wounds.