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Query: UMLS:C0004153 (atherosclerosis)
 77,401 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Peripheral arterial disease is characterized by a gradual reduction in blood to the extremities secondary to atherosclerosis. In diabetes, the pattern of atherosclerotic occlusion typically shows a propensity toward the infrapopliteal vessels. Additionally, impairment of the microcirculation manifests in diminished vasoreactivity and a functional ischemia that is not always correctable with surgery. However, when a nonhealing wound is complicated by peripheral arterial disease, revascularization is paramount to wound healing. Revascularization can be accomplished through traditional bypass surgery or newer endovascular interventions, such as angioplasty and stenting. These less invasive techniques of revascularization offer the advantages of quicker recovery and lower morbidity but durability may be compromised. Ultimately, the choice of revascularization procedure should be based on the clinical characteristics of the atherosclerotic lesion along with the individual patient history.
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PMID:Peripheral arterial disease and diabetes: a clinical update. 1944 96

Peripheral arterial disease is a common clinical condition and represents a manifestation of systemic atherosclerosis. It has been demonstrated that peripheral arterial disease impairs significantly quality of life, and thus its improvement has become an important goal of therapy, particularly in symptomatic patients. In addition, the impact of this disease on quality of life is not adequately described by physical examination findings and common clinical data, such as the ankle-brachial index. Thus, to properly understand the clinical evolution of peripheral arterial disease and its treatment, it is useful to integrate clinical outcome measures with data derived from the patient's point of view in order to avoid that procedural success is evaluated only in terms of appropriate use of the available technical tools and of a good angiographic result without taking into account its consequences on daily future life of patients. It would therefore be necessary that the caregivers involved in the evaluation and treatment of patients with peripheral arterial disease are able to use and interpret the validated instruments for quality of life assessment. Among therapeutic strategies, percutaneous transluminal angioplasty is emerging as a suitable option to improve both clinical outcome and quality of life, even though it cannot contrast the progression of atherosclerotic disease. In this article we review major generic and specific instruments to assess patient-reported quality of life. Moreover, we describe the impact of peripheral arterial disease and its endovascular treatment on quality of life.
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PMID:[Assessment of quality of life in patients with peripheral arterial disease: a problem left ahead]. 1947 76

Peripheral arterial disease (PAD) is an important global healthcare problem associated with considerable morbidity and mortality. This disease is an important manifestation of atherosclerosis and the pathophysiological processes involved in its development, progression and complications are atherothrombosis and thromboembolism. Over 150 years ago, Virchow described a triad of abnormalities (abnormal blood flow, abnormal vessel wall and abnormal blood constituents) associated with thrombus formation (thrombogenesis). An improvement in biochemical techniques has allowed quantification of various components of Virchow's triad, and as a consequence, there has been increasing interest in the measurement of such biomarkers in understanding the development and progression of PAD, as well as its symptomatic complications. This review discusses quantifiable components of Virchow's triad that have been associated with PAD and their clinical utility as risk factors for PAD.
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PMID:Peripheral arterial disease and Virchow's triad. 1949 44

Peripheral arterial disease is an underecognized manifestation of systemic atherosclerosis associated with high rates of cardiovascular morbidity and mortality. The rationale of therapy is to reduce cardiovascular risk, improve symptoms of intermittent claudication, and prevent the development of critical limb ischemia and amputation. Exercise therapy and several pharmacologic agents have been shown to improve walking distance in patients with intermittent claudication. Patients with lifestyle-interfering symptoms despite exercise, or those who progress to critical limb ischemia, frequently undergo revascularization. Endovascular techniques are commonly used in these patients. Combined pharmacological and endovascular strategies will play an increasing role in management of these patients in the future.
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PMID:Treatment strategies for peripheral artery disease. 1952 86

Peripheral arterial disease (PAD) is highly prevalent. Patients with PAD have often manifestations of atherosclerosis in other vascular territories and are at increased risk for cardiovascular events. Typical symptoms are intermittent claudication or rest pain and acral lesions in patients with advanced PAD. The majority of PAD patients is clinically asymptomatic, therefore it makes sense to look for PAD in patients with cardiovascular risk factors. The ankle brachial index (ABI = ankle/arm pressure) is regarded as an easy and cost effective method for baseline diagnostic. If ABI measurement confirms the suspected PAD, a detailed diagnostic pathway should follow in which duplex sonography plays a central role. In some cases additional radiologic imaging is necessary to complete the diagnostic or to plan therapeutic procedures.
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PMID:[Peripheral arterial disease: epidemiology, symptoms and diagnosis]. 1958 92

Peripheral arterial disease (PAD) is a progressive disease most often due to atherosclerosis and characterized by obstruction of arterial blood flow in the lower limbs. The defining symptom of PAD, intermittent claudication, is evident in only a minority of patients, leading to frequent underdiagnosis. Patients with PAD are more likely to suffer from polyvascular disease than patients with other cardiovascular conditions and have an increased risk of cardiovascular death and ischemic events. This review considers current PAD awareness and treatment, including important findings from the REduction of Atherothrombosis for Continued Health (REACH) and PAD Awareness, Risk and Treatment: New Resources for Survival (PARTNERS) registries. Information on simple diagnostic tools to aid early PAD detection and therapeutic options for global atherosclerosis risk factor management are also presented.
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PMID:The importance of early diagnosis and treatment in peripheral arterial disease: insights from the PARTNERS and REACH registries. 1975 16

The number of diabetics will increase almost 70% in developed countries during the next 20 years. Peripheral arterial disease is a common and costly complication among diabetics. The incidence of cardiovascular disease (mortality and morbidity) due to atherosclerosis, is higher among patients with diabetes than in those without diabetes. Also, amputation incidence is 5-10-fold higher compared to nondiabetics. Due to neuropathy, infections and underlying PAD, ulcers in diabetic foot leads too often to amputation. Urgent evaluation of lower extremity circulation, treatment of infections and surgical procedures, including revisions and revascularizations, are often needed. Intensive management of diabetes, including glycaemic and platelet aggregation control, treatment of hypertension and dyslipidemia, as well as nonpharmacological interventions, decreases both micro- and macrovascular complications.
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PMID:Diabetic foot: prevention and interventions. 1979 27

Peripheral arterial disease (PAD) is a clinical manifestation of underlying aorto-iliac and leg atherosclerosis that is characterized by different stages of stenosis and obstruction. It affects approximately 12% of the adult population and about 20% of people over the age of 70 years, and is associated with increased cardiovascular (CV) and cerebrovascular morbidity. Intermittent claudication (IC) is the major symptom of PAD; it is defined as cramping leg pain (in the buttock, thigh, or calf) while/after clim bing one or two flights of stairs, or during walking. The goals of IC management are to: slow the progression of local and systemic atherosclerosis, prevent major fatal and nonfatal CV events (myocardial infarction and stroke), improve walking capacity, prevent and reduce resting pain and cutaneous lesions. Propionyl L-carnitine is an acyl derivative of levocarnitine (L-carnitine) and is indicated for patients with peripheral arterial occlusive disease. It corrects secondary muscle carnitine deficiency in patients with PAD, significantly improving the walking capacity; it is a free radical that produces positive effects on endothelial function; it protects from oxidative stress; and it enhances most measures of quality of life. The recent Trans-Atlantic Inter-Society Consensus II update recommends the use of propionyl L-carnitine in combination with physical training to improve the symptoms associated with PAD.
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PMID:Propionyl l-carnitine: intermittent claudication and peripheral arterial disease. 1982 91

Peripheral arterial disease (PAD) is chronic arterial occlusive disease of the lower extremities caused by atherosclerosis whose prevalence increases with age. Only one-half of women with PAD are symptomatic. Symptomatic and asymptomatic women with PAD are at increased risk for all-cause mortality, cardiovascular mortality, and mortality from coronary artery disease. Modifiable risk factors that predispose women to PAD include active cigarette smoking, passive smoking, diabetes mellitus, hypertension, dyslipidemia, increased plasma homocysteine levels and hypothyroidism. With regard to management, women who smoke should be encouraged to quit and referred to a smoking cessation program. Hypertension, diabetes mellitus, dyslipidemia, and hypothyroidism require treatment. Statins reduce the incidence of intermittent claudication and improve exercise duration until the onset of intermittent claudication in women with PAD and hypercholesterolemia. Anti-platelet drugs such as aspirin or especially clopidogrel, angiotensin-converting enzyme inhibitors and statins should be given to all women with PAD. Beta blockers are recommended if coronary artery disease is present. Exercise rehabilitation programs and cilostazol increase exercise time until intermittent claudication develops. Chelation therapy should be avoided as it is ineffective. Indications for lower extremity percutaneous transluminal angioplasty or bypass surgery in women are (1) incapacitating claudication interfering with work or lifestyle; and (2) limb salvage in women with limb-threatening ischemia as manifested by rest pain, non-healing ulcers, and/or infection or gangrene. Future research includes investigation of mechanisms underlying why women have a higher risk of graft failure and major amputation.
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PMID:Peripheral arterial disease in women. 1985 89

Peripheral arterial disease (PAD), a manifestation of systemic atherosclerosis, is a marker for coronary artery, cerebrovascular, and renal artery atherosclerotic vascular disease. Patients with PAD have an increased risk of cardiovascular events such as myocardial infarction and stroke in addition to significant impairment in their quality of life and physical function. Early detection and implementation of guideline-recommended therapies are paramount to effective treatment of PAD. Measurement of the ankle-brachial index is a simple, reliable, and noninvasive test to diagnose PAD that can be used in a primary care setting. Lifestyle modification, including exercise and smoking cessation, combined with pharmacologic therapy to manage risk factors have been shown effective in reducing cardiovascular risks in patients with PAD. Evidence suggests, however, that there is currently a lack of awareness regarding PAD among physicians and patients, leading to underdiagnosis and undertreatment. This paper reviews the epidemiology, pathology, and clinical implications of PAD, and offers current evidence for disease management quality improvement initiatives to enhance patient care.
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PMID:Peripheral arterial disease: considerations in risks, diagnosis, and treatment. 1986 Feb 99


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