Peripheral Arterial Disease: Difference between revisions
No edit summary |
No edit summary |
||
| Line 12: | Line 12: | ||
In the United Kingdom, an estimated 500-1000 new cases of PAD are diagnosed per million each year<ref name="Patient">Patient. Peripheral arterial disease. http://www.patient.co.uk/doctor/peripheral-arterial-disease (accessed 9 May 2015)</ref><ref name="Peach">Peach, G, Griffin, M, Jones, KG, Thompson MM, Hinchliffe, RJ. Diagnosis and management of peripheral arterial disease. BMJ 2012; 345: 1-8. http://www.bmj.com/content/bmj/345/bmj.e5208.full.pdf (acccessed 9 May 2015)</ref>. Patients at high risk of PAD are those with cardiac disease, diabetes mellitus, older than 70 years or 50 years old with multiple cardiovascular factors<ref name="Mahameed">Mahameed, AA, Bartholomew, JR, Disease of Peripheral Vessels. In: Topol, EJ, editor. Textbook of Cardiovascular Medicine. 3rd ed. New York: Lippincott Williams &amp;amp; Wilkins, 2007, p.1531-1537</ref>. These factors include smoking, dyslipedmia, dysglycemia, hypertension, family history of atherosclerotic vascular disease. In lower socioeconomic areas, PAD is more frequent as a result of increased incidence of smoking <ref name="Fowkes">Fowkes G. Peripheral vascular disease. 2010. http://www.birmingham.ac.uk/Documents/college-mds/haps/projects/HCNA/09HCNA3D2.pdf (accessed 9 May 2015)</ref>. Some studies report no difference in prevalence between the sexes <ref name="Mahameed" />, however, other studies have found a 3:1 ratio comparing men to women<ref name="Fowkes" /><ref name="Patient" />. A few studies have suggested that black non-Hispanics have an increased prevalence of PAD, with a reported 2.39 to 2.83 odd ratio. Although, a study that controlled for atherosclerotic risk factors found a small difference between whites and African Americans; 1.54 and 1.89, respectively<ref name="Collins">Collines, TC, Petersen, NJ, Suarez-Almazor, M, Ashton CM. Ethnicity and peripheral arterial disease. Mayo Clin Proc. 2005; 80(1): 48-54.</ref>. The majority of cases are asymptomatic.. | In the United Kingdom, an estimated 500-1000 new cases of PAD are diagnosed per million each year<ref name="Patient">Patient. Peripheral arterial disease. http://www.patient.co.uk/doctor/peripheral-arterial-disease (accessed 9 May 2015)</ref><ref name="Peach">Peach, G, Griffin, M, Jones, KG, Thompson MM, Hinchliffe, RJ. Diagnosis and management of peripheral arterial disease. BMJ 2012; 345: 1-8. http://www.bmj.com/content/bmj/345/bmj.e5208.full.pdf (acccessed 9 May 2015)</ref>. Patients at high risk of PAD are those with cardiac disease, diabetes mellitus, older than 70 years or 50 years old with multiple cardiovascular factors<ref name="Mahameed">Mahameed, AA, Bartholomew, JR, Disease of Peripheral Vessels. In: Topol, EJ, editor. Textbook of Cardiovascular Medicine. 3rd ed. New York: Lippincott Williams &amp;amp; Wilkins, 2007, p.1531-1537</ref>. These factors include smoking, dyslipedmia, dysglycemia, hypertension, family history of atherosclerotic vascular disease. In lower socioeconomic areas, PAD is more frequent as a result of increased incidence of smoking <ref name="Fowkes">Fowkes G. Peripheral vascular disease. 2010. http://www.birmingham.ac.uk/Documents/college-mds/haps/projects/HCNA/09HCNA3D2.pdf (accessed 9 May 2015)</ref>. Some studies report no difference in prevalence between the sexes <ref name="Mahameed" />, however, other studies have found a 3:1 ratio comparing men to women<ref name="Fowkes" /><ref name="Patient" />. A few studies have suggested that black non-Hispanics have an increased prevalence of PAD, with a reported 2.39 to 2.83 odd ratio. Although, a study that controlled for atherosclerotic risk factors found a small difference between whites and African Americans; 1.54 and 1.89, respectively<ref name="Collins">Collines, TC, Petersen, NJ, Suarez-Almazor, M, Ashton CM. Ethnicity and peripheral arterial disease. Mayo Clin Proc. 2005; 80(1): 48-54.</ref>. The majority of cases are asymptomatic.. | ||
== Aetiology == | == Aetiology == | ||
The most common cause of PAD is atherosclerosis, similarly, they share the same risk factors: smoking, diabetes, age, hypertension, and hyperlipidemia. Uncommon vascular symptoms, such as vasculitis, thromboangiitis obliterans, popliteal entrapment syndrome, and fibromuscular dysplasis, account for less than 10% of cases <ref name="Mahameed" />. Atherosclerosis is the formation of lipid deposits in the tunica media and associated with damage to the endothelial lining <ref name="Martini">Martini, FH, Nath, JL, Bartholomew, EF. Fundamentals of anatomy and physiology. San Francisco: Pearson Education, 2015.</ref>.The endothelial cells become swollen with lipids and create a gap between in the linings. Platelets stick to the exposed collagen fibers, forming a localized clot that restricts arterial blood flow, leading to inadequate tissue perfusion. This and other complex interactions can lead to progression from asymptomatic PAD, Intermittent Claudication, Critical Limb Ischemia, Acute Limb Ischemia <ref name="Mahameed" />. | The most common cause of PAD is '''atherosclerosis''', similarly, they share the same risk factors: smoking, diabetes, age, hypertension, and hyperlipidemia. Uncommon vascular symptoms, such as vasculitis, thromboangiitis obliterans, popliteal entrapment syndrome, and fibromuscular dysplasis, account for less than 10% of cases <ref name="Mahameed" />. Atherosclerosis is the formation of lipid deposits in the tunica media and associated with damage to the endothelial lining <ref name="Martini">Martini, FH, Nath, JL, Bartholomew, EF. Fundamentals of anatomy and physiology. San Francisco: Pearson Education, 2015.</ref>.The endothelial cells become swollen with lipids and create a gap between in the linings. Platelets stick to the exposed collagen fibers, forming a localized clot that restricts arterial blood flow, leading to inadequate tissue perfusion. This and other complex interactions can lead to progression from asymptomatic PAD, Intermittent Claudication, Critical Limb Ischemia, Acute Limb Ischemia <ref name="Mahameed" />. | ||
Cigarette smoking increases the chance of having PAD by seven-fold <ref name="Price">Price, JF, Mowbray, PI, Lee, AJ, Rumley, A, Lowe, GDO, Fowkes, FGR. 1999, “Relationship between smoking and cardiovascular risk factors in the development of peripheral arterial disease and coronary artery disease”, European Heart Journal, Vol. 20, pp. 344-353.</ref>. Due to a change in the fibrin formation, endothelial cells, blood rheology, and lipoproteins decrease antioxidants in the blood <ref name="Price" />. Specifically, the change in endothelial cells that line the arterial walls is strongly associated with atherosclerosis <ref name="Hirsch">Hirsch, AT, et al. 2006, “Practice Guidelines for the Management of Patients With Peripheral Arterial Disease (Lower Extremity, Renal, Mesenteric, and Abdominal Aortic)”, Circulation, Vol. 113, pp. 463-654.</ref>. As the number of cigarettes smoked each day increase, so does the risk of PAD <ref name="Price" />. | Cigarette '''smoking '''increases the chance of having PAD by seven-fold <ref name="Price">Price, JF, Mowbray, PI, Lee, AJ, Rumley, A, Lowe, GDO, Fowkes, FGR. 1999, “Relationship between smoking and cardiovascular risk factors in the development of peripheral arterial disease and coronary artery disease”, European Heart Journal, Vol. 20, pp. 344-353.</ref>. Due to a change in the fibrin formation, endothelial cells, blood rheology, and lipoproteins decrease antioxidants in the blood <ref name="Price" />. Specifically, the change in endothelial cells that line the arterial walls is strongly associated with atherosclerosis <ref name="Hirsch">Hirsch, AT, et al. 2006, “Practice Guidelines for the Management of Patients With Peripheral Arterial Disease (Lower Extremity, Renal, Mesenteric, and Abdominal Aortic)”, Circulation, Vol. 113, pp. 463-654.</ref>. As the number of cigarettes smoked each day increase, so does the risk of PAD <ref name="Price" />. | ||
Diabetes, similarly to smoking causes abnormalities in endothelial cells and their function. The cells are unable to regulate the function and structure of the arterial walls<ref name="Creager">Creager, MA, Luscher, TF, Beckman, JA. Diabetes and vascular disease: Pathophysiology, clinical consquences and medical therapy. Circulation 2003;108:1527-1532.</ref>. Diabetes Mellitus leads to a two-to fourfold increase in risk of cardiovascular events <ref name="Mahameed" />. | '''Diabetes''', similarly to smoking causes abnormalities in endothelial cells and their function. The cells are unable to regulate the function and structure of the arterial walls<ref name="Creager">Creager, MA, Luscher, TF, Beckman, JA. Diabetes and vascular disease: Pathophysiology, clinical consquences and medical therapy. Circulation 2003;108:1527-1532.</ref>. Diabetes Mellitus leads to a two-to fourfold increase in risk of cardiovascular events <ref name="Mahameed" />. | ||
Age | '''Age''' | ||
The risk of PAD increases as the population approaches the age of 50. It has been reported that PAD affects 0.9% of 40-49 year olds and increases to 14.5% of 70 year olds and above <ref name="Mahameed" />.Studies also have shown that men are the target population of PAD <ref name="Mahameed" />. | The risk of PAD increases as the population approaches the age of 50. It has been reported that PAD affects 0.9% of 40-49 year olds and increases to 14.5% of 70 year olds and above <ref name="Mahameed" />.Studies also have shown that men are the target population of PAD <ref name="Mahameed" />. | ||
<br>Hypertension | <br>'''Hypertension''' | ||
In a study conducted by Lewington et al. illustrated that for each 20-mmHg increase in systolic blood pressure or 10 mmHG in diastolic for people age 40-70 doubled the risk of cardiovascular disease and PAD <ref name="Mahameed" />. | In a study conducted by Lewington et al. illustrated that for each 20-mmHg increase in systolic blood pressure or 10 mmHG in diastolic for people age 40-70 doubled the risk of cardiovascular disease and PAD <ref name="Mahameed" />. | ||
<br>Dyslipidemia<br>Developing PAD by 10% for every 10-mg/dL rise in total cholesterol<ref name="Mahameed" />. <br> | <br>'''Dyslipidemia'''<br>Developing PAD by 10% for every 10-mg/dL rise in total cholesterol<ref name="Mahameed" />. <br> | ||
== Investigations == | == Investigations == | ||
Revision as of 20:10, 30 May 2015
Original Editors - Students from Glasgow Caledonian University's Cardiorespiratory Therapeutics Project.
Top Contributors - Victoria Michaud, Lucinda hampton, Kim Jackson, Admin, Adam Vallely Farrell, Chris Seenan, Vidya Acharya, 127.0.0.1, Michelle Lee and WikiSysop
Definition/Description[edit | edit source]
Peripheral arterial disease (PAD) is known as a condition where by the blood flow in the limb arteries are obstructed [1]. Commonly, the legs are the most affected [1]. These arteries are obstructed due to plaque deposits that restrict blood flow through the peripheries [2]. Although blood flow may be also restricted by deep vein thrombosis, which may be a blood clot that occurs in the periphery of the limbs [2]. Common symptoms of PAD include pain during walking and rest, skin ulcers, cramping, aching, clubbing of the finger or toenails, cold skin, blue tinged skin, and slow blood refill [3]. Thus there is a lack of blood flow to remove anaerobic metabolites that cause a pain sensation when built up [2].
Epidemiology[edit | edit source]
In the United Kingdom, an estimated 500-1000 new cases of PAD are diagnosed per million each year[4][5]. Patients at high risk of PAD are those with cardiac disease, diabetes mellitus, older than 70 years or 50 years old with multiple cardiovascular factors[3]. These factors include smoking, dyslipedmia, dysglycemia, hypertension, family history of atherosclerotic vascular disease. In lower socioeconomic areas, PAD is more frequent as a result of increased incidence of smoking [6]. Some studies report no difference in prevalence between the sexes [3], however, other studies have found a 3:1 ratio comparing men to women[6][4]. A few studies have suggested that black non-Hispanics have an increased prevalence of PAD, with a reported 2.39 to 2.83 odd ratio. Although, a study that controlled for atherosclerotic risk factors found a small difference between whites and African Americans; 1.54 and 1.89, respectively[7]. The majority of cases are asymptomatic..
Aetiology[edit | edit source]
The most common cause of PAD is atherosclerosis, similarly, they share the same risk factors: smoking, diabetes, age, hypertension, and hyperlipidemia. Uncommon vascular symptoms, such as vasculitis, thromboangiitis obliterans, popliteal entrapment syndrome, and fibromuscular dysplasis, account for less than 10% of cases [3]. Atherosclerosis is the formation of lipid deposits in the tunica media and associated with damage to the endothelial lining [8].The endothelial cells become swollen with lipids and create a gap between in the linings. Platelets stick to the exposed collagen fibers, forming a localized clot that restricts arterial blood flow, leading to inadequate tissue perfusion. This and other complex interactions can lead to progression from asymptomatic PAD, Intermittent Claudication, Critical Limb Ischemia, Acute Limb Ischemia [3].
Cigarette smoking increases the chance of having PAD by seven-fold [9]. Due to a change in the fibrin formation, endothelial cells, blood rheology, and lipoproteins decrease antioxidants in the blood [9]. Specifically, the change in endothelial cells that line the arterial walls is strongly associated with atherosclerosis [10]. As the number of cigarettes smoked each day increase, so does the risk of PAD [9].
Diabetes, similarly to smoking causes abnormalities in endothelial cells and their function. The cells are unable to regulate the function and structure of the arterial walls[11]. Diabetes Mellitus leads to a two-to fourfold increase in risk of cardiovascular events [3].
Age
The risk of PAD increases as the population approaches the age of 50. It has been reported that PAD affects 0.9% of 40-49 year olds and increases to 14.5% of 70 year olds and above [3].Studies also have shown that men are the target population of PAD [3].
Hypertension
In a study conducted by Lewington et al. illustrated that for each 20-mmHg increase in systolic blood pressure or 10 mmHG in diastolic for people age 40-70 doubled the risk of cardiovascular disease and PAD [3].
Dyslipidemia
Developing PAD by 10% for every 10-mg/dL rise in total cholesterol[3].
Investigations[edit | edit source]
A tool used to gain a diagnosis of PAD is Ankle Brachial Pressure Index (ABI), a simple and inexpensive test that measures the ratio between blood pressure in the legs to the blood pressure in the arms[3]. The lower the pressure in the legs illustrates that PAD is present. An ABI of 0.9- 1.0 is normal, 0.70-0.89 is a mild disease, 0.40- 0.69 is a moderate disease, and less than .40 is a severe PAD[3]. When measuring for ABI, make sure the patient is calm and in a rested position [12]. It is also important to assess individuals if they have diabetes, non-healing wounds on their legs and feet, unexplained pain in their peripherals, and check for femoral and popliteal pulses[12].
Clinical Manifestations[edit | edit source]
[12]
non-healing wounds on legs or feet
unexplained leg pain
pain on walking that resolves when stopped
pain in foot at rest made which worsens with elevation
ulcers
gangrene
dry skin
cramping
aching
Physiotherapy and Other Management[edit | edit source]
One method of treating PAD is to reduce cardiovascular risk factors by quitting smoking, managing diabetes mellitus, treating dyslipidemia and hypertension [3]. Another method is to treat PAD symptoms to improve quality of life through pharmacotherapy, exercise rehabilitation program, revascularization, thrombolysis and surgical procedures [3]. The least invasive and most appropriate treatment conducted by Physiotherapists would be by prescribing an exercise program. The recommended parameters of physical exercise are a 6 month program of 30-35 minutes walking sessions at a frequency of 3-5 times a week at near-maximal pain tolerant [3]. NICE recommends PAD patients to exercise at near-maximal pain for a total of 2 hours per week for 3 months to improve quality of life [12].
Prevention[edit | edit source]
Brief consideration of how this pathology could be prevented and the physiotherapy role in health promotion in relation to prevention of disease or disease progression.
Resources
[edit | edit source]
http://www.nhs.uk/conditions/peripheralarterialdisease/Pages/Introduction.aspx
http://www.circulationfoundation.org.uk/help-advice/peripheral-arterial-disease/
Recent Related Research (from Pubmed)[edit | edit source]
see tutorial on Adding PubMed Feed
Extension:RSS -- Error: Not a valid URL: addfeedhere|charset=UTF-8|short|max=10
References[edit | edit source]
see adding references tutorial.
- ↑ 1.0 1.1 Henderson, J, Pollack, A, Harrison, C, Miller, G. 2013, “Peripheral arterial disease”, Australian Family Physician, Vol. 42, no. 6, pp. 363.
- ↑ 2.0 2.1 2.2 Warren, E. Ten things the practice nurse can do about peripheral arterial disease. Practice Nurse 2013; 43; 12: 14-18.
- ↑ 3.00 3.01 3.02 3.03 3.04 3.05 3.06 3.07 3.08 3.09 3.10 3.11 3.12 3.13 3.14 Mahameed, AA, Bartholomew, JR, Disease of Peripheral Vessels. In: Topol, EJ, editor. Textbook of Cardiovascular Medicine. 3rd ed. New York: Lippincott Williams &amp; Wilkins, 2007, p.1531-1537
- ↑ 4.0 4.1 Patient. Peripheral arterial disease. http://www.patient.co.uk/doctor/peripheral-arterial-disease (accessed 9 May 2015)
- ↑ Peach, G, Griffin, M, Jones, KG, Thompson MM, Hinchliffe, RJ. Diagnosis and management of peripheral arterial disease. BMJ 2012; 345: 1-8. http://www.bmj.com/content/bmj/345/bmj.e5208.full.pdf (acccessed 9 May 2015)
- ↑ 6.0 6.1 Fowkes G. Peripheral vascular disease. 2010. http://www.birmingham.ac.uk/Documents/college-mds/haps/projects/HCNA/09HCNA3D2.pdf (accessed 9 May 2015)
- ↑ Collines, TC, Petersen, NJ, Suarez-Almazor, M, Ashton CM. Ethnicity and peripheral arterial disease. Mayo Clin Proc. 2005; 80(1): 48-54.
- ↑ Martini, FH, Nath, JL, Bartholomew, EF. Fundamentals of anatomy and physiology. San Francisco: Pearson Education, 2015.
- ↑ 9.0 9.1 9.2 Price, JF, Mowbray, PI, Lee, AJ, Rumley, A, Lowe, GDO, Fowkes, FGR. 1999, “Relationship between smoking and cardiovascular risk factors in the development of peripheral arterial disease and coronary artery disease”, European Heart Journal, Vol. 20, pp. 344-353.
- ↑ Hirsch, AT, et al. 2006, “Practice Guidelines for the Management of Patients With Peripheral Arterial Disease (Lower Extremity, Renal, Mesenteric, and Abdominal Aortic)”, Circulation, Vol. 113, pp. 463-654.
- ↑ Creager, MA, Luscher, TF, Beckman, JA. Diabetes and vascular disease: Pathophysiology, clinical consquences and medical therapy. Circulation 2003;108:1527-1532.
- ↑ 12.0 12.1 12.2 12.3 NICE National Institute for Health and Care Excellence. Lower limb peripheral arterial disease: diagnosis and management, 2012. https://www.nice.org.uk/guidance/cg147/chapter/guidance#management-of-intermittent-claudication (accessed 9 May 2015)
