Medical Management of Peripheral Arterial Disease

Peripheral artery disease (PAD) is estimated to affect 27 million individuals in Europe and North America and its prevalence is increasing in concert with recent demographic and risk factor trends. 1 The majority of patients with PAD are either asymptomatic or have atypical leg symptoms, with classical claudication in only 10-35%, therefore detection is elusive unless actively sought. 2 Given shared risk factors, it is axiomatic that there exists a high co-prevalence of atherosclerosis in other vascular beds including the coronary arteries in PAD patients. However, PAD disproportionately affects the elderly, non-whites, and women compared with CAD alone. 3, 4 The actual co-prevalence of CAD in patients with established PAD depends on how closely it is searched for, with clinical history and ECG detecting only 20-40% of co-existing disease whereas cardiac catheterization detects CAD in as many as 90% of PAD patients. 5, 6