Basics PAD

• • To a large extent atherosclerotic disease wherever it presents in the body and it arises from medical risk factors, lifestyle risk factors, environmental risk factors and non-modifiable risk factors
  • Thinking about risk factors it is also worth noting that the main preventable risk factors driving the development of peripheral artery disease are:
  • Smoking
  • Having diabetes – particularly where glycaemic control is poor
• • As with many disease states PAD is a progressive disease and hence the clinical presentation covers a spectrum ranging from asymptomatic PAD right through to critical limb ischaemia and the possibility of requiring an amputation
• Prime PAD path = atherosclerosis:

  • generalised arterial pathology
  • atheroma/plaques i.e. a collection of lipids, cholesterol, fibroblasts and skeletal muscle cells and collagen fibres - lying under the intima and projecting into the lumen within peripheral circulation
  • associated with:
  • endothelial dysfunction (nitric oxide) and limited vasodilation
  • vessel stenosis and tissue ischaemia
  • possibly thrombus formation
• • PAD/PAOD is a marker by proxy of atherosclerotic disease of the coronary and cerebral circulation
  • 40 to 60% with PAD will have coronary artery disease and cerebral artery disease
  • 20 to 30% with symptomatic PAD will die within 5 years due to cardiovascular events (stroke, AMI etc)
  • prime goal of PAD management is the reduction of cardiovascular risk factors