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Peripheral Arterial Disease
Peripheral arterial disease (PAD) affects 10 to 20 percent of the United States senior citizen population, approximately 8 million people. According to the American Heart Association, diabetes mellitus is among the prevalent risk factors for peripheral arterial disease (PAD). The recently released 2006 American Diabetes Association consensus statement presented clinical data that one in three patients with diabetes mellitus (DM) are known to have PAD. See below for related articles on peripheral arterial disease.
Treatment of Peripheral Arterial Disease in the Elderly Person
Persons with peripheral arterial disease (PAD) are at increased risk for all-cause mortality, cardiovascular mortality, and mortality from coronary artery disease (CAD). Modifiable risk factors such as cessation of cigarette smoking and control of dyslipidemia, hypertension, and diabetes should be treated. Statins decrease the incidence of intermittent claudication and improve exercise duration, as well as reduce cardiovascular events and mortality in persons with PAD and hypercholesterolemia. Antiplatelet drugs and angiotensin-converting enzyme inhibitors should be administered to all persons with PAD. Beta-blockers should be given if CAD is present. Exercise rehabilitation programs and cilostazol improve exercise time until intermittent claudication. Indications for lower-extremity angioplasty or bypass surgery include incapacitating claudication, limb salvage in persons with limb-threatening ischemia, and impotence of vascular origin. Amputation should be performed if tissue loss has progressed beyond the point of salvage, if surgery is too risky, if life expectancy is very short, or if functional limitations reduce the benefit of limb salvage. (Annals of Long-Term Care: Clinical Care and Aging 2005;13[9]: 35-40)
Featured Content from Annals of Long-Term Care
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CME Article: Peripheral Arterial Disease and the Older Adult: More Sinister than It Appears
Educational Objectives 1. To understand the epidemiology and risk factors for the development of peripheral arterial disease 2. To recognize the clinical signs and symptoms of peripheral arterial disease 3. To be able to treat the symptoms of peripheral arterial disease 4. To be able to prevent the cardiovascular morbidity and mortality associated with peripheral arterial disease The term peripheral arterial disease (PAD) refers to atherosclerotic disease of the lower extremities and is ...
Featured Content from Clinical Geriatrics
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May 2005
ACCREDITATION The Johns Hopkins University School of Medicine is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. CREDIT DESIGNATION STATEMENT The Johns Hopkins University School of Medicine designates this educational activity for a maximum of 1.0 category 1 credit toward the AMA Physician? Estimated time: 1 hour EDUCATIONAL OBJECTIVES 1. To understand the epidemiology and risk factors for the development of ...
Featured Content from Clinical Geriatrics
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Vascular Atherosclerotic Risk Prevention in Patients with Peripheral Arterial Disease
Smoking cessation, on average, will prevent 1 cardiovascular mortality for 13.5 patients abstaining for 1 year.19 Treatment of 38 patients with moderate exercise for one year would prevent one cardiovascular death.22 Aspirin therapy will prevent one major cardiovascular event [defined as stroke, myocardial infarction (MI) or cardiovascular death] in 106 patient years; clopidogrel therapy will prevent one major cardiovascular event in 84 patient years;3 ticlopidine therapy for similar time ...
Featured Content from Vascular Disease Management
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Diabetic Foot Amputation: The Need for an Objective Assessment Tool
Abstract: The diabetic patient is at increased risk of peripheral arterial disease that may lead to critical ischemia with subsequent sequelae for the legs and feet. Too frequently, surgical amputation is the only option for managing nonviable digits and feet. While it is desirable to prevent this state by risk factor management, patients will develop these complications. What is a satisfactory measure of tissue viability of the lower extremity in these patients?
Featured Content from Wounds Research
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What is the Diagnosis? Critical Leg Ischemia
Abstract: A 72-year-old Caucasian woman gave a one-year history of redness, itching, and increasing pain of the left foot. Based on her clinical history and physical examination, she was diagnosed with peripheral vascular disease leading to critical leg ischemia. In this article, the presentation, significant physical findings, etiology, and treatment plans for the patient are discussed.
Featured Content from Wounds Research
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How To Diagnose Peripheral Arterial Disease
Peripheral arterial disease can result in a range of serious complications and possibly death. Accordingly, this author offers a closer look at non-invasive testing and assesses the pros and cons of these tests at the microcirculation and macrocirculation levels.
Featured Content from Podiatry Today
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Impact of Gender on In-Hospital Outcomes Following Contemporary Percutaneous Intervention for Peripheral Arterial Disease
Impact of Gender on In-Hospital Outcomes Following Contemporary Percutaneous Intervention for Peripheral Arterial Disease Feature: Impact of Gender on In-Hospital Outcomes Following Contemporary Percutaneous Intervention for Peripheral Arterial Disease - Akio Kawamura, MD, Thomas C. Piemonte, MD, Richard W. Nesto, MD, Seth D. Bilazarian, MD, Nabila S. Riskalla, RN, Manish S. Chauhan, MD Abstract Background. Percutaneous peripheral arterial intervention (PPAI) has emerged as an effective and ...
Featured Content from Vascular Disease Management
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Therapeutic Angiogenesis for the Treatment of PAD ? Where Do We Stand?
Following this description of gene therapy in a patient with PAD, several phase I trials have been conducted, mostly using genes to induce angiogenesis. Regional Angiogenesis with Vascular Endothelial Growth Factor (VEGF) in peripheral arterial disease: Design of the RAVE trial. Regional angiogenesis with vascular endothelial growth factor in peripheral arterial disease: A phase II randomized, double-blind, controlled study of adenoviral delivery of vascular endothelial growth factor 121 in...
Featured Content from Vascular Disease Management
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Drug Therapy for Older Persons With Hypercholesterolemia and Vascular Disease: The Value of Secondary Prevention
Drug Therapy for Older Persons With Hypercholesterolemia and Vascular Disease: The Value of Secondary Prevention Drug Therapy for Older Persons With Hypercholesterolemia and Vascular Disease: The Value of Secondary Prevention Wilbert S. Aronow, MD, CMD Older persons who have elevated serum low-density lipoprotein cholesterol levels despite dietary therapy and who have the following diseases should be treated with reductase inhibitor drug therapy: those with coronary artery disease, to reduce ...
Featured Content from Annals of Long-Term Care
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