Overview
Definition
Atherosclerotic narrowing of the peripheral arteries, most commonly affecting the lower extremities, leading to decreased blood flow.
Epidemiology
Affects >200 million people globally. A major marker for systemic atherosclerosis (high risk for MI/Stroke).
Etiology & Risk Factors
- Atherosclerosis
Clinical Symptoms
- Claudication (muscle pain/cramping in calves/thighs that occurs with walking and is relieved by rest)
- Rest pain (in advanced disease/critical limb ischemia)
- Cold, pale, or cyanotic extremities
- Hair loss on legs, poor nail growth
- Non-healing arterial ulcers (typically on the toes or lateral malleolus)
Clinical Approach
Diagnosis
- Ankle-Brachial Index (ABI) ≤ 0.90 is diagnostic
- Arterial Duplex Ultrasound
- CT Angiography or MR Angiography (for anatomic mapping before revascularization)
Management
- Risk factor modification (Strict smoking cessation, High-intensity Statin, BP and Glycemic control)
- Antiplatelet therapy (Aspirin or Clopidogrel) to prevent MI/Stroke
- Symptom relief: Cilostazol, structured exercise programs
- Revascularization (Endovascular angioplasty/stent or Surgical bypass) for critical limb ischemia or lifestyle-limiting claudication
Complications
- Critical Limb Ischemia
- Gangrene
- Amputation
- High risk of concurrent Myocardial Infarction or Stroke