Peripheral Arterial Disease

Abstract

October 2005

Section 1 Cardiovascular Medicine

XVI Peripheral Arterial Disease

Mark A. Creager, M.D.
Professor of Medicine, Harvard Medical School; and Director, Vascular Center, and Head, Vascular Medicine Section, Cardiovascular Division, Brigham and Women's Hospital

Peripheral arterial diseases compromise blood flow to the limbs; common causes of arterial obstruction include atherosclerosis, acute arterial occlusion, vasculitis, arterial entrapment, adventitial cysts, fibromuscular dysplasia, and vasospasm. A review of atherosclerosis, the most common cause of peripheral arterial disease, considers epidemiology, risk factors, diagnosis, and diagnostic tests. Tables highlight the Fontaine classification and clinical categories of chronic limb ischemia. An overview of the treatment of atherosclerosis addresses risk factor modification, antiplatelet therapy, hygiene, physical therapy, drug therapy for claudication and ongoing pharmacologic research, and revascularization. This chapter discusses the etiology, diagnosis, and treatment of acute arterial occlusion, such as embolism, thrombosis, dissection, and trauma, as well as atheroembolism, popliteal artery entrapment, thromboangiitis obliterans, and Raynaud phenomenon. A table summarizes secondary causes of Raynaud phenomenon, and the differential diagnosis of acrocyanosis is discussed. Figures illustrate dependent rubor in an ischemic foot, pulse volume recordings, arteriograms in patients with critical foot ischemia and disabling leg claudication, and atheroemboli to the toes. This chapter contains 75 references.

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