Epidemiology

Atherosclerotic peripheral vascular disease (PVD) is an underdiagnosed, undertreated, age-dependent disease that profoundly impacts patient quality of life, and is an independent predictor of mortality (Criqui et al., 1992; Nikolsky et al., 2004; Vogt et al., 1993). On average the mortality rate of claudicant patients is 2.5 times higher than nonclaudicant patients (Fig. 27-22).

Follow up (years)

Figure 27-22 Survival of patients with intermittent claudication and matched controls. (Reprinted with permission from the Society of Vascular Surgery. Dormandy JA, Rutherford RB. Management of peripheral arterial disease (PAD). TransAtlantic Inter-Society Consensus (TASC). J Vasc Surg 2000;31:S1-S296, Figure 12.)

Follow up (years)

Figure 27-22 Survival of patients with intermittent claudication and matched controls. (Reprinted with permission from the Society of Vascular Surgery. Dormandy JA, Rutherford RB. Management of peripheral arterial disease (PAD). TransAtlantic Inter-Society Consensus (TASC). J Vasc Surg 2000;31:S1-S296, Figure 12.)

Atherosclerosis is a ubiquitous process of chronic low-grade inflammation with superimposed acute thrombotic events (Libby, 2001) that affects the entire arterial tree in the coronary, cerebral, visceral, and upper and lower extremity circulation. Patients with PVD are at increased risk of cardiovascular and cerebrovascular events, including death, MI, and stroke. The clinical continuum of PVD ranges from asymptomatic stenosis to limb-threatening ischemia. Intermittent claudication (IC) is defined as ischemic limb pain in one or both legs that occurs with exertion and is alleviated with rest. IC is associated with marked limitations in walking ability, which translates into a considerable negative impact on occupational, social, and leisure activities (Regensteiner et al., 1990; Olsen et al., 1988; Vogt et al., 1994).

Atherosclerosis begins in childhood and evolves over decades (Freedman et al., 1988), affecting more than 85% of adults over age 50 (Tuzcu et al., 2001). However, many patients remain entirely asymptomatic; thus estimating the true prevalence of PVD is difficult and highly dependent on the definition of disease. Most epidemiologic studies only report symptomatic disease; therefore the true incidence of PVD is not accurately known and underestimated. In addition, published reports on the incidence and prevalence of PVD vary greatly because the true occurrence of disease is directly related to the risk group of the population studied, and the sensitivity and specificity of the diagnostic testing methodology (Criqui et al., 1985).

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