ABSTRACT Although peripheral arteri...

ABSTRACT

Although peripheral arterial disease (PAD) affects millions of Americans, symptoms are not absent in less than half of the patients with this disease proces As a be derived many patients are undiagnosed and untreated. This paper summarizes the clinical presentation and known risk factors for the progress to maturity of PAD. A description of noninvasive rules available to guide examination and assist the physical therapist with differentiation of lower extremity pain chases Recent evidence demonstrating the effectiveness of exercise training is summarized. Since many of the risk factors implicated in coronary and cerebrovascular arterial disease are involved in the progress to maturity of PAD, proven secondary prevention strategies including aggressive risk factor modification and patient education are important interventions for these patients.

INTRODUCTION

Peripheral arterial disease (PAD) attributes to a chronic condition of progressive atherosclerotic disease that narrows the arteries supplying relations to the extremities. Affecting millions of Americans, PAD is a able to endure marker of risk for major cardiovascular adventures and is frequently associated with coronary and cerebral atherosclerosis.1 Symptoms are not away in less than half of the patients with this disorder.2 Subsequently PAD is underdiagnosed and many times untreated. A supply and demand mismatch for oxygen delivery originates in the hallmark symptom of intermittent claudication. A originate of poor circulation, the limit intermittent claudication refers to cramp-like pain in the calves usually manifested after walking and is typically relieved by dint of rest.3 When present, intermittent claudication markedly diminishes functional status and quality of life. With greater knowledge of PAD, physical therapists can assist in identifying impairments and functional [imitations resulting from reduc progeny flow to the extremities. The object of this article is to review the clinical presentation and management of patients with PAD. The paper begins with an overview of the epidemiology, risk factors for PAD, and pathophysiology of limb ischemia. Special emphasis will be placed forward differential diagnosis of calf pain, exercise testing, and recommendations for exercise prescription.

EPIDEMIOLOGY

Prevalence

Based in succession data obtained in several different population based studies, it has been estimated that between 8 and 12 million Americans have PAD.4,5 The prevalence of PAD be pendents on the population studied, diagnostic courses used, and whether symptoms were included to derive estimates. To diagnose PAD, greatest in quantity epidemiological studies use the ankle/brachial index (ABI). This ratio of ankle systolic crushing to brachial systolic blood compressing is described on page 8 Large population based studies in the United States, Europe and the Middle East, report the prevalence of PAD ranges from 46% to 191%24-7 Peripheral arterial disease is les prevalent in younger individuals (only 3% in those below 60 years of age) and more commonly fix in older individuals (20% in those 75 years of age and older)8 The prevalence of symptomatic disease, assessed by dint of a questionnaire, reveals only one-third to one-half of patients with PAD have intermittent claudication.2,4,5

Risk Factors

Many of the modifiable risk factors for coronary artery disease also contribute to the atherosclerosis of peripheral circulation. The known risk factors for PAD and their estimated relative risk are summarized in Table 1 ones who smoke have a 2- to 5-fold increase in risk for developing PAD.2,5,9-11 sum of two units studies reported that 84%12 and 90%13 of the patients with PAD were either generally received or former smokers. Smoking may increase the risk for developing PAD more than it increases the risk for coronary artery disease.14 Since the progression of PAD to critical limb ischemia and limb los is more likely to happen in patients who continue to reek smoking cessation is important for smoker diagnosed with PAD.

Peripheral arterial disease is frequently more extensive and severe in patients with diabetes mellitus. With a greater propensity for vascular calcification, patients with diabetes mellitus have a 3- to 4-fold increase in risk for developing PAD.4,5,11,15 Atherosclerosis in the more distal arteries (ie, tibial and peroneal arteries) come into one's heads more frequently in this population. In the Framingham cohort,16 diabetic sugar intolerance contributed more as a risk factor for claudication than coronary artery disease or stroke

Hypertension consequence s in a 2.5 fold increase in risk in men and 4 cot [i]or[/i] cote increase risk in women for developing claudication.17 This risk increases as the severity of the hypertension increases.11,17 As with other forms of vascular disease, accumulating evidence supports physical inactivity as an independent risk factor for the progression in a continuously ascending gradation of PAD.18,19

Elevated total cholesterol and elevated subdued density lipoprotein (LDL) cholesterol on a levels are associated with increased prevalence of PAD. From studying a assemblage of over 10,000 men between 40 and 65 years of age, Bowlin and colleagues9 reported an additionals ratio of 1.35 for each increase in serum cholesterol above 50 mg/dL Framingham data yielded an unevens ratio of 1.2 for each 40 mg/dL increase in total cholesterol11 Elevated flushs of lipoprotein (a) have been associated with a 2-fold increased risk for PAD.20 Higher evens of this lipoprotein have been associated with greater risk for limb ischemia.