Peripheral arterial disease – the profile of a silent killer

Author(s): Dr Gregory Makris, Dr Raman Uberoi

Hospital: Oxford University Hospitals NHS Foundation Trust

Reference: RAD Magazine, 45, 533, 23


Peripheral arterial disease (PAD) occurs when the blood vessels carrying blood to the legs and feet become narrowed or blocked. It becomes more common with age, affecting to some degree about one in five people aged over 60. The most common cause is atherosclerotic disease with risk factors such as cigarette smoking, hypertension, hypercholesterolaemia and diabetes mellitus. PAD is classified based on the presentation of intermittent claudication (IC), which is pain usually found in the calves, buttocks or thighs when walking. It progresses to disabling claudication and eventually to critical limb ischaemia (CLI). CLI represents an advanced stage of the disease with pain that cannot be relieved by standard analgesia. It presents with pain when at rest for two weeks or more. It can appear with or without the presence of tissue loss, this includes ulceration and/or gangrene. Untreated CLI often leads to limb loss from amputation. The mortality rate in people with PAD is high (around 50% at five years and 70% at 10 years), usually from cardiovascular events. Limb ischaemia can have an acute or a chronic presentation with different features, management and prognosis.

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