Peripheral artery disease explained

Peripheral artery disease
Field:Interventional radiology, vascular surgery
Synonyms:Peripheral vascular disease (PVD), peripheral artery occlusive disease, peripheral obliterative arteriopathy
Symptoms:Leg pain when walking that resolves with rest, skin ulcers, bluish skin, cold skin
Complications:Infection, amputation
Causes:Atherosclerosis, artery spasm
Risks:Cigarette smoking, diabetes, high blood pressure, high blood cholesterol.
Diagnosis:Ankle-brachial index < 0.90, duplex ultrasonography, angiography
Treatment:Stopping smoking, supervised exercise therapy, surgery
Medication:Statins, ACE inhibitors, cilostazol
Frequency:155 million (2015)
Deaths:52,500 (2015)

Peripheral artery disease (PAD) is a vascular disorder that causes abnormal narrowing of arteries other than those that supply the heart or brain.[1] [2] PAD can happen in any blood vessel, but it is more common in the legs than the arms.[3]

When narrowing occurs in the heart, it is called coronary artery disease (CAD), and in the brain, it is called cerebrovascular disease. Peripheral artery disease most commonly affects the legs, but other arteries may also be involved, such as those of the arms, neck, or kidneys.[4]

Peripheral artery disease (PAD) is a form of peripheral vascular disease. Vascular refers to both the arteries and veins within the body. PAD differs from peripheral veinous disease. PAD means the arteries are narrowed or blocked—the vessels that carry oxygen-rich blood as it moves away from the heart to other parts of the body. Peripheral veinous disease, on the other hand, refers to problems with veins—the vessels that bring the blood back to the heart.

The classic symptom is leg pain when walking, which resolves with rest and is known as intermittent claudication. Other symptoms include skin ulcers, bluish skin, cold skin, or abnormal nail and hair growth in the affected leg.[5] Complications may include an infection or tissue death, which may require amputation; coronary artery disease; or stroke.[6] Up to 50% of people with PAD do not have symptoms.[7]

The greatest risk factor for PAD is cigarette smoking. Other risk factors include diabetes, high blood pressure, kidney problems, and high blood cholesterol. PAD is primarily caused by the buildup of fatty plaque in the arteries, which is called atherosclerosis, especially in individuals over 40 years old.[8] Other mechanisms include artery spasm, blood clots, trauma, fibromuscular dysplasia, and vasculitis.[9] PAD is typically diagnosed by finding an ankle-brachial index (ABI) less than 0.90, which is the systolic blood pressure at the ankle divided by the systolic blood pressure of the arm.[10] Duplex ultrasonography and angiography may also be used.[11] Angiography is more accurate and allows for treatment at the same time; however, it is associated with greater risks.

It is unclear if screening for peripheral artery disease in people without symptoms is useful, as it has not been properly studied.[12] [13] [14] For those with intermittent claudication from PAD, stopping smoking and supervised exercise therapy may improve outcomes.[15] Medications, including statins, ACE inhibitors, and cilostazol, may also help.[16] [17] Aspirin, which helps with thinning the blood and thus improving blood flow, does not appear to help those with mild disease but is usually recommended for those with more significant disease due to the increased risk of heart attacks.[18] [19] Anticoagulants (blood thinners) such as warfarin show no definitive scientific evidence of benefit in PAD.[20] Surgical procedures used to treat PAD include bypass grafting, angioplasty, and atherectomy.[21]

In 2015, about 155 million people had PAD worldwide.[22] It becomes more common with age.[23] In the developed world, it affects about 5.3% of 45- to 50-year-olds and 18.6% of 85- to 90-year-olds. In the developing world, it affects 4.6% of people between the ages of 45 and 50 and 15% of people between the ages of 85 and 90. PAD in the developed world is equally common among men and women, though in the developing world, women are more commonly affected.[24] In 2015, PAD resulted in about 52,500 deaths, which is an increase from the 16,000 deaths in 1990.[25] [26]

Signs and symptoms

The signs and symptoms of peripheral artery disease are based on the part of the body that is affected. About 66% of patients affected by PAD either do not have symptoms or have atypical symptoms.[9] The most common presenting symptom is intermittent claudication (IC), which typically refers to lower extremity skeletal muscle pain that occurs during exercise. IC presents when there is insufficient oxygen delivery to meet the metabolic requirements of the skeletal muscles. IC is a common manifestation of peripheral arterial disease (PAD). The pain is usually located in the calf muscles of the affected leg and is relieved by rest. This occurs because during exercise, the muscles require more oxygen. Normally, the arteries would be able to increase the amount of blood flow and therefore increase the amount of oxygen going to the exercised muscle. However, in PAD, the artery is unable to respond appropriately to the increased demand for oxygen from the muscles, and as a result, the muscles are deprived of oxygen, leading to muscle pain that subsides with rest.

Other symptoms may include:[27]

In individuals with severe PAD, complications may arise, including critical limb ischemia and gangrene. Critical limb ischemia occurs when the obstruction of blood flow in the artery is compromised to the point where the blood is unable to maintain oxygenation of the tissue at rest. This can lead to pain at rest, a feeling of coldness, or numbness in the affected foot and toes. Other complications of severe PAD include lower limb tissue loss (amputation), arterial insufficiency ulcers, erectile dysfunction, and gangrene.[28] People with diabetes are affected by gangrene of the feet at a rate that is 30 times higher than the unaffected population. Many of these severe complications, such as those leading to amputation, are irreversible.[29]

Causes

Risk factors

Factors contributing to an increased risk of PAD are the same as those for atherosclerosis.[30] [31] These include age, sex, and ethnicity.[32] PAD is twice as common in males as in females. In terms of ethnicity, PAD is more common in people of color compared to the white population in a 2:1 ratio.[33] The factors with the greatest risk associations are hyperlipidemia, hypertension, diabetes mellitus, chronic kidney disease, and smoking. Presenting three of these factors or more increases the risk of developing PAD tenfold.[34]

High risk populations

Peripheral arterial disease is more common in these populations:[45]

Etiology and pathophysiology

Peripheral arterial disease is considered to be a set of chronic or acute syndromes, generally derived from the presence of occlusive arterial disease, which causes inadequate blood flow to the limbs.[46]

As previously mentioned, the most common etiology of peripheral artery disease, especially in patients over 40 years old, is atherosclerosis. Atherosclerosis is a narrowing of the arteries caused by lipid or fat buildup and calcium deposition in the wall of the affected arteries.

The pathophysiology of atherosclerosis involves complex interactions between cholesterol and vascular cells. In the early stages of PAD, the arteries compensate for the plaque buildup by dilating to preserve flow through the vessel. Eventually, the artery cannot dilate any further, and the atherosclerotic plaque starts to narrow the arterial flow lumen.

When there is an imbalance between the needs of the peripheral tissues and the blood supply, we are faced with a situation of ischemia.

From the pathophysiologic point of view, a restriction of blood supply (ischemia) to the lower limbs can be classified as either functional or critical. Functional ischemia occurs when the blood flow is normal at rest but insufficient during exercise, presenting clinically as intermittent claudication. Critical ischemia is produced when the reduction in blood flow results in a perfusion deficit at rest and is defined by the presence of pain at rest or trophic lesions in the legs. In this situation, precise diagnosis is fundamental, as there is a clear risk of loss of the limb if adequate blood flow is not re-established, either by surgery or by endovascular therapy. Differentiating between the two concepts is important in order to establish the therapeutic indication and the prognosis in patients with PAD.

Other causes include vasculitis and in situ thrombosis related to hypercoagulable states.[47] Additional mechanisms of peripheral artery disease include arterial spasm and fibromuscular dysplasia. The cause and pathophysiology of arterial spasm are not fully understood, but it is hypothesised that they can occur secondary to trauma.[48] The symptoms of claudication ensue when the artery spasms, or clamps down on itself, creating an obstruction. Similar to atherosclerosis, this leads to decreased blood flow to the tissue downstream of the obstruction. Thrombosis, or the formation of a blood clot, usually occurs due to stasis or trauma.

Diagnosis

Diagnosing or identifying peripheral artery disease requires a history of symptoms and a physical exam, followed by confirmatory testing. These tests could include CT scans (Computed Tomographic Angiography), MRA scans (Magnetic Resonance Angiography), or ultrasounds for imaging.[27] In the setting of symptoms consistent with peripheral artery disease, a physician will then examine an individual for specific exam findings. Abnormal physical exam findings can lead a health care provider to consider a specific diagnosis. However, in order to confirm a diagnosis, confirmatory testing is required.

These findings are associated with peripheral artery disease:

If peripheral artery disease is suspected, the initial study is the ankle–brachial index (ABI). The ABI is a simple, non-invasive test that measures the ratio of systolic blood pressure in the ankle to the systolic blood pressure in the upper arm. This is based on the idea that if blood pressure readings in the ankle are lower than those in the arm, a blockage in the arteries that provide blood from the heart to the ankle is suspected.[49] An ABI range of 0.90 to 1.40 is considered normal. A person is considered to have PAD when the ABI is ≤ 0.90. However, PAD can be further graded as mild to moderate if the ABI is between 0.41 and 0.90, and severe if the ABI is less than 0.40. These categories can provide insight into the disease course. Furthermore, ABI values of 0.91 to 0.99 are considered borderline, and values >1.40 indicate noncompressible arteries. If an ABI >1.40 is calculated, this could indicate vessel wall stiffness caused by calcification, which can occur in people with uncontrolled diabetes. Abnormally high ABIs (>1.40) are usually considered false negatives, and thus, such results merit further investigation and higher-level studies.[50] Individuals with noncompressible arteries have an increased risk of cardiovascular mortality within a two-year period.[51]

Individuals with suspected PAD with normal ABIs can undergo exercise testing for ABI. A baseline ABI is obtained prior to exercise. The patient is then asked to exercise (usually patients are made to walk on a treadmill at a constant speed) until claudication pain occurs (for a maximum of 5 minutes), after which the ankle pressure is again measured. A decrease in ABI of 15%–20% would be diagnostic of PAD.

If ABIs are abnormal, the next step is generally a lower limb Doppler ultrasound to look at the site of obstruction and extent of atherosclerosis. Other imaging can be performed by angiography, where a catheter is inserted into the common femoral artery and selectively guided to the artery in question. While injecting a radio-dense contrast agent, an X-ray is taken. Any blood flow-limiting blockage found in the X-ray can be identified and treated by procedures including atherectomy, angioplasty, or stenting. Contrast angiography is the most readily available and widely used imaging technique. Modern computerized tomography (CT) scanners provide direct imaging of the arterial system. Studies have shown the sensitivity and specificity of CT in identifying lesions with >50% stenosis to be 95% and 96%, respectively.[52] As such, CT may be considered as an alternative to invasive angiography. An important distinction between the two is that, unlike invasive angiography, assessment of the arterial system with CT does not allow for vascular intervention.[53]

Magnetic resonance angiography (MRA) is a noninvasive diagnostic procedure that uses a combination of a large magnet, radio frequencies, and a computer to produce detailed images of blood vessels inside the body. The advantages of MRA include its safety and ability to provide high-resolution, three-dimensional imaging of the entire abdomen, pelvis, and lower extremities in one sitting.[54] [55]

Classification

The two most commonly used methods to classify peripheral artery disease are the Fontaine and Rutherford systems of classification.[56] The Fontaine stages were introduced by René Fontaine in 1954 to define the severity of chronic limb ischemia:[45] [57]

The Rutherford classification was created by the Society for Vascular Surgery and the International Society of Cardiovascular Surgery, introduced in 1986 and revised in 1997 (and known as the Rutherford classification after the lead author, Robert B. Rutherford). This classification system consists of four grades and seven categories (categories 0–6):[58]

Moderate to severe PAD, classified by Fontaine's stages III to IV or Rutherford's categories 4 to 5, presents a limb threat (risk of limb loss) in the form of critical limb ischemia.[59]

Recently, the Society for Vascular Surgery came out with a classification system based on "wound, ischemia and foot infection" (WIfI).[60] This classification system, published in 2013, was created to account for the demographic changes that have occurred over the past forty years, including the increased incidence of high blood sugar and evolving techniques and abilities for revascularization. This system was created on the basis that ischemia and angiographic disease patterns are not the sole determinants of amputation risk. The WIfI classification system is broken up into two parts: wounds and ischemia. Wounds are graded 0 through 3 based on the presence of ulceration, gangrene, and ischemia.

Ischemia is graded 0 through 3 based on ABI, ankle systolic pressure, and toe pressure.

The TASC (and TASC II) classification suggests PAD treatment is based on the severity of disease seen on an angiogram.

Screening

It is not clear if screening for disease in the general population is useful, as it has not been extensively studied. This includes screening with the ankle-brachial index[61] (ABI), although a systematic review of the literature did not support the use of routine ABI screening in asymptomatic patients.[62]

Testing for coronary artery disease or carotid artery disease is of unclear benefit.[14] While PAD is a risk factor for abdominal aortic aneurysms (AAA), there is no data on screening individuals with asymptomatic PAD for abdominal aortic aneurysms.[14] For people with symptomatic PAD, screening by ultrasound for AAA is not unreasonable.[14]

Wearable devices and remote patient monitoring

A 2022 review found that a variety of wearable medical devices measuring different parameters (such as body temperature) were being combined with remote patient monitoring of PAD patients, in a goal to improve health outcomes.[63]

Some studies propose the development of devices measuring oxygen continuously during exercise. This is because resting perfusion and metabolic activity are extremely low and differences between non-patients and PAD patients are barely measurable. As such, testing of vascular function and energetics requires a physiological challenge.[64] Pulse oximeters can be inconvenient to wear during exercise and only give oxygen values at discrete time points, nor is there sufficient evidence to support any use in identifying PAD. Some publications and studies therefore discuss the use of wearable sensors measuring oxygen levels continuously in PAD patients, such as through transcutaneous means. However, because transcutaneous measurements are affected by movement (such as during exercise) and body temperature, use of oxygen sensors that are inserted subcutaneously as opposed to transcutaneously may most effectively help monitor a PAD patient’s progress and direct therapy decisions.[65] To date, one oxygen sensing system has been approved for use in Europe to measure tissue perfusion in all PAD patients.[66]

Treatment

Depending on the severity of the disease, these steps can be taken, according to these guidelines:

Lifestyle

Medication

According to guidelines, taking aspirin or clopidogrel is recommended to reduce AMI ("heart attack"), stroke, and other causes of vascular death in people with symptomatic peripheral artery disease. It is recommended that aspirin and clopidogrel be taken alone and not in conjunction with one another (i.e., not as dual antiplatelet therapy). The recommended daily dosage of aspirin for treating PAD is between 75 and 325 mg, while the recommended daily dosage for clopidogrel is 75 mg.[34] The effectiveness of both aspirin and clopidogrel to reduce the risk of cardiovascular ischemic events in people with symptomatic PAD is not well established. Research also suggests that low-dose rivaroxaban plus aspirin is effective as a new anti-thrombotic regimen for PAD.[67]

Cilostazol can improve symptoms in some people. Pentoxifylline is of unclear benefit.[68] Cilostazol may improve walking distance for people who experience claudication due to peripheral artery disease, but no strong evidence suggests that it improves the quality of life, decreases mortality, or decreases the risk of cardiovascular events.

Treatment with other drugs or vitamins is unsupported by clinical evidence, "but trials evaluating the effect of folate and vitamin B12 on hyperhomocysteinemia, a putative vascular risk factor, are near completion".

Revascularization

After a trial of the best medical treatment outlined above, if symptoms persist, patients may be referred to a vascular or endovascular surgeon. The benefit of revascularization is thought to correspond to the severity of ischemia and the presence of other risk factors for limb loss, such as wound and infection severity.[69]

Guidelines

A guideline from the American College of Cardiology and American Heart Association for the diagnosis and treatment of lower extremity, renal, mesenteric, and abdominal aortic PAD was compiled in 2013, combining the 2005 and 2011 guidelines.[76] For chronic limb-threatening ischemia, the ACCF/AHA guidelines recommend balloon angioplasty only for people with a life expectancy of 2 years or less or those who do not have an autogenous vein available. For those with a life expectancy greater than 2 years or who have an autogenous vein, bypass surgery is recommended.[77]

Prognosis

Individuals with PAD have an "exceptionally elevated risk for cardiovascular events and the majority will eventually die of a cardiac or cerebrovascular etiology".[78] Prognosis is correlated with the severity of the PAD as measured by an ABI.[78] Large-vessel PAD increases mortality from cardiovascular disease significantly. PAD carries a greater than "20% risk of a coronary event in 10 years".[78]

The risk is low that an individual with claudication will develop severe ischemia and require amputation, but the risk of death from coronary events is three to four times higher than matched controls without claudication.[79] Of patients with intermittent claudication, only "7% will undergo lower-extremity bypass surgery, 4% major amputations, and 16% worsening claudication", but stroke and heart attack events are elevated, and the "5-year mortality rate is estimated to be 30% (versus 10% in controls)".[78]

Epidemiology

The prevalence of PAD in the general population is 3–7%, affecting up to 20% of those over 70;[80] 70%–80% of affected individuals are asymptomatic; only a minority ever require revascularization or amputation. Peripheral artery disease affects one in three diabetics over the age of 50. In the US, it affects 12–20 percent of Americans age 65 and older. Around 10 million Americans have PAD. Despite its prevalence and implications for cardiovascular risk, there are still low levels of awareness of risk factors and symptoms, with 26% of the population in the US reported to have knowledge of PAD.[81]

In 2000, among people aged 40 years and older in the United States, rates of PAD were 4.3%.[82] Rates were 14.5% for people aged 70 years or over. Within age groups, rates were generally higher for women than men. Non-Hispanic blacks had a rate of 7.9% compared to 4.4% in Non-Hispanic whites and 3.0% (1.4%–4.6%) in Mexican Americans.[82]

The incidence of symptomatic PAD increases with age, from about 0.3% per year for men aged 40–55 years to about 1% per year for men aged over 75 years. The prevalence of PAD varies considerably depending on how PAD is defined and the age of the population being studied. People diagnosed with PAD have a greater risk of a MACE (Major Adverse Cardiac Event) and stroke. Their risk of developing a reinfarction, stroke, or transient ischemic attack within one year following a heart attack increases to 22.9%, compared to 11.4% for those without PAD.[83]

The Diabetes Control and Complications Trial and the UK Prospective Diabetes Study trials in people with type 1 and type 2 diabetes, respectively, demonstrated that glycemic control is more strongly associated with microvascular disease than macrovascular disease. Pathologic changes occurring in small vessels may be more sensitive to chronically elevated glucose levels than atherosclerosis occurring in larger arteries.[84]

Research

Research is being done on therapies to prevent the progression of PAD.[85] In those who have developed critically poor blood flow to the legs, the benefit of autotransplantation of autologous mononuclear cells is unclear.[86]

Only one randomized controlled trial has been conducted comparing vascular bypass to angioplasty for the treatment of severe PAD.[87] The trial found no difference in amputation-free survival between vascular bypass and angioplasty at the planned clinical endpoint, but the trial has been criticized as being underpowered, limiting endovascular options, and comparing inappropriate endpoints.[88] As of 2017, two randomized clinical trials are being conducted to better understand the optimal revascularization technique for severe PAD and critical limb ischemia (CLI), the BEST-CLI (Best Endovascular Versus Best Surgical Therapy for Patients With Critical Limb Ischemia) Trial and the BASIL-2 (Bypass Versus Angioplasty in Severe Ischaemia of the Leg – 2)Trial.[89] [90]

In 2011, pCMV-vegf165 was registered in Russia as the first-in-class gene therapy drug for the treatment of PAD, including the advanced stage of critical limb ischemia.[91] [92]

External links

Notes and References

  1. Web site: What Is Peripheral Vascular Disease?. American Heart Association (heart.org). 26 February 2015. 2012. live. https://web.archive.org/web/20150412121230/http://www.heart.org/idc/groups/heart-public/%40wcm/%40hcm/documents/downloadable/ucm_300323.pdf. April 12, 2015. mdy-all. Peripheral artery disease (PAD) is the narrowing of the arteries to the legs, stomach, arms and head..
  2. Web site: Overview of Peripheral Arterial Disease – Heart and Blood Vessel Disorders . Merck Manuals Consumer Version . 30 April 2019 . en-CA . Disorders of arteries that supply the brain with blood are considered separately as cerebrovascular disease..
  3. Creager MA, Loscalzo J . 2018 . Arterial Diseases of the Extremities Chapter 275 . Harrison's Principles of Internal Medicine . McGraw Hill . 20 . subscription . 10 April 2023 . Access Medicine.
  4. Shantulli S . Update on peripheral arterial disease: Epidemiology and evidence-based facts . Atherosclerosis . 2018.
  5. Web site: What Are the Signs and Symptoms of Peripheral Arterial Disease?. nhlbi.nih.gov. 26 February 2015. August 2, 2011. live. https://web.archive.org/web/20150225174501/http://www.nhlbi.nih.gov/health/health-topics/topics/pad/signs. February 25, 2015. mdy-all.
  6. Web site: What Is Peripheral Arterial Disease?. nhlbi.nih.gov. 25 February 2015. August 2, 2011. live. https://web.archive.org/web/20150225065759/http://www.nhlbi.nih.gov/health/health-topics/topics/pad/. February 25, 2015. mdy-all.
  7. Book: Violi F, Basili S, Berger JS, Hiatt WR . Antiplatelet Therapy in Peripheral Artery Disease . Antiplatelet Agents . Handbook of Experimental Pharmacology . 210 . 210 . 547–563 . 2012 . 22918746 . 10.1007/978-3-642-29423-5_22 . 978-3-642-29422-8 .
  8. Web site: August 2, 2011 . What Causes Peripheral Arterial Disease? . live . https://web.archive.org/web/20150225172141/http://www.nhlbi.nih.gov/health/health-topics/topics/pad/causes . February 25, 2015 . 26 February 2015 . nhlbi.nih.gov . mdy-all.
  9. Book: Harrison's principles of internal medicine. . 2018 . McGraw-Hill Education / Medical . 9781259644047 . 20.
  10. Ruiz-Canela M, Martínez-González MA . Lifestyle and dietary risk factors for peripheral artery disease . Circulation Journal . 78 . 3 . 553–559 . 2014 . 24492064 . 10.1253/circj.cj-14-0062 . free .
  11. Web site: How Is Peripheral Arterial Disease Diagnosed?. 27 March 2015. August 2, 2011. live. https://web.archive.org/web/20150407063439/http://www.nhlbi.nih.gov/health/health-topics/topics/pad/diagnosis. April 7, 2015. mdy-all.
  12. Andras A, Ferket B . Screening for peripheral arterial disease . The Cochrane Database of Systematic Reviews . 4 . 4 . CD010835 . April 2014 . 24711093 . 10.1002/14651858.CD010835.pub2 . 11103656 .
  13. U.S. Preventive Services Task Force. Peripheral artery disease screening and cardiovascular disease risk assessment with the ankle-brachial index in adults: recommendation statement.. Am Fam Physician. Dec 15, 2014. 90. 12. 858A–858D. live. https://web.archive.org/web/20170331210746/http://www.aafp.org/afp/2014/1215/od1.html. March 31, 2017. mdy-all.
  14. Gerhard-Herman MD, Gornik HL, Barrett C, Barshes NR, Corriere MA, Drachman DE, Fleisher LA, Fowkes FG, Hamburg NM, Kinlay S, Lookstein R, Misra S, Mureebe L, Olin JW, Patel RA, Regensteiner JG, Schanzer A, Shishehbor MH, Stewart KJ, Treat-Jacobson D, Walsh ME . 6 . 2016 AHA/ACC Guideline on the Management of Patients With Lower Extremity Peripheral Artery Disease: Executive Summary: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines . Journal of the American College of Cardiology . 69 . 11 . 1465–1508 . March 2017 . 27851991 . 10.1016/j.jacc.2016.11.008 .
  15. Hageman D, Fokkenrood HJ, Gommans LN, van den Houten MM, Teijink JA . Supervised exercise therapy versus home-based exercise therapy versus walking advice for intermittent claudication . The Cochrane Database of Systematic Reviews . 2018 . 4 . CD005263 . April 2018 . 29627967 . 6513337 . 10.1002/14651858.CD005263.pub4 .
  16. Hankey GJ, Norman PE, Eikelboom JW . Medical treatment of peripheral arterial disease . JAMA . 295 . 5 . 547–553 . February 2006 . 16449620 . 10.1001/jama.295.5.547 .
  17. Brown T, Forster RB, Cleanthis M, Mikhailidis DP, Stansby G, Stewart M . Cilostazol for intermittent claudication . The Cochrane Database of Systematic Reviews . 2021 . 6 . CD003748 . June 2021 . 34192807 . 8245159 . 10.1002/14651858.CD003748.pub5 .
  18. Lin JS, Olson CM, Johnson ES, Whitlock EP . The ankle-brachial index for peripheral artery disease screening and cardiovascular disease prediction among asymptomatic adults: a systematic evidence review for the U.S. Preventive Services Task Force . Annals of Internal Medicine . 159 . 5 . 333–341 . September 2013 . 24026319 . 10.7326/0003-4819-159-5-201309030-00007 . 9350462 .
  19. Poredos P, Jezovnik MK . Is aspirin still the drug of choice for management of patients with peripheral arterial disease? . VASA. Zeitschrift für Gefässkrankheiten . 42 . 2 . 88–95 . March 2013 . 23485835 . 10.1024/0301-1526/a000251 .
  20. Hauk L . ACCF/AHA update peripheral artery disease management guideline . American Family Physician . 85 . 10 . 1000–1001 . May 2012 . 22612053 .
  21. Web site: How Is Peripheral Arterial Disease Treated?. nhlbi.nih.gov. 26 February 2015. August 2, 2011. live. https://web.archive.org/web/20150225174450/http://www.nhlbi.nih.gov/health/health-topics/topics/pad/treatment. February 25, 2015. mdy-all.
  22. Vos T, Allen C, Arora M, Barber RM, Bhutta ZA, Brown A, etal . GBD 2015 Disease and Injury Incidence and Prevalence Collaborators . Global, regional, and national incidence, prevalence, and years lived with disability for 310 diseases and injuries, 1990-2015: a systematic analysis for the Global Burden of Disease Study 2015 . Lancet . 388 . 10053 . 1545–1602 . October 2016 . 27733282 . 5055577 . 10.1016/S0140-6736(16)31678-6 .
  23. Book: Vascular medicine : a companion to Braunwald's heart disease. 2013. Elsevier/Saunders. Creager MA, Beckman JA, Loscalzo J . 9781455737369. 2nd. Philadelphia, PA. 810335904.
  24. Fowkes FG, Rudan D, Rudan I, Aboyans V, Denenberg JO, McDermott MM, Norman PE, Sampson UK, Williams LJ, Mensah GA, Criqui MH . 6 . Comparison of global estimates of prevalence and risk factors for peripheral artery disease in 2000 and 2010: a systematic review and analysis . Lancet . 382 . 9901 . 1329–1340 . October 2013 . 23915883 . 10.1016/s0140-6736(13)61249-0 . 38652734 .
  25. Global, regional, and national life expectancy, all-cause mortality, and cause-specific mortality for 249 causes of death, 1980-2015: a systematic analysis for the Global Burden of Disease Study 2015 . Lancet . 388 . 10053 . 1459–1544 . October 2016 . 27733281 . 5388903 . 10.1016/s0140-6736(16)31012-1 . Wang . Haidong . Naghavi . Mohsen . Allen . Christine . Barber . Ryan M. . Bhutta . Zulfiqar A. . Carter . Austin . Casey . Daniel C. . Charlson . Fiona J. . Chen . Alan Zian . Coates . Matthew M. . Coggeshall . Megan . Dandona . Lalit . Dicker . Daniel J. . Erskine . Holly E. . Ferrari . Alize J. . Fitzmaurice . Christina . Foreman . Kyle . Forouzanfar . Mohammad H. . Fraser . Maya S. . Fullman . Nancy . Gething . Peter W. . Goldberg . Ellen M. . Graetz . Nicholas . Haagsma . Juanita A. . Hay . Simon I. . Huynh . Chantal . Johnson . Catherine O. . Kassebaum . Nicholas J. . Kinfu . Yohannes . Kulikoff . Xie Rachel . 1 .
  26. Global, regional, and national age-sex specific all-cause and cause-specific mortality for 240 causes of death, 1990-2013: a systematic analysis for the Global Burden of Disease Study 2013 . Lancet . 385 . 9963 . 117–171 . January 2015 . 25530442 . 4340604 . 10.1016/S0140-6736(14)61682-2 .
  27. Web site: CDC. 2021-09-27. Peripheral Arterial Disease (PAD) cdc.gov. 2021-11-10. Centers for Disease Control and Prevention. en-us.
  28. Book: Current medical diagnosis & treatment 2019. Papadakis MA, McPhee SJ, Rabow RW . 9781260117431. Fifty-eighth . New York, N.Y.. 1048597590 . 2018-09-07.
  29. Sahu A, Sagar R, Sarkar S, Sagar S . Psychological effects of amputation: A review of studies from India . Industrial Psychiatry Journal . 25 . 1 . 4–10 . 2016 . 28163401 . 5248418 . 10.4103/0972-6748.196041 . free .
  30. . Retrieved August 9, 2010.
  31. Joosten MM, Pai JK, Bertoia ML, Rimm EB, Spiegelman D, Mittleman MA, Mukamal KJ . Associations between conventional cardiovascular risk factors and risk of peripheral artery disease in men . JAMA . 308 . 16 . 1660–1667 . October 2012 . 23093164 . 3733106 . 10.1001/jama.2012.13415 .
  32. Web site: Atherosclerotic peripheral artery disease. Elsevier Point of Care. 11 December 2018. Clinical Key. 14 December 2018.
  33. Web site: Peripheral Artery Disease. The Lecturio Medical Concept Library . 4 October 2021.
  34. Avery DM, Skinner CA, Reed MD . Supporting Family Physician Maternity Care Providers . Family Medicine . 51 . 4 . 362 . April 2019 . 30973629 . 10.22454/fammed.2019.636289 . 108295670 . free .
  35. Price JF, Mowbray PI, Lee AJ, Rumley A, Lowe GD, Fowkes FG . Relationship between smoking and cardiovascular risk factors in the development of peripheral arterial disease and coronary artery disease: Edinburgh Artery Study . European Heart Journal . 20 . 5 . 344–353 . March 1999 . 10206381 . 10.1053/euhj.1998.1194 . free .
  36. Smith GD, Shipley MJ, Rose G . Intermittent claudication, heart disease risk factors, and mortality. The Whitehall Study . Circulation . 82 . 6 . 1925–1931 . December 1990 . 2242518 . 10.1161/01.cir.82.6.1925 . free .
  37. Cole CW, Hill GB, Farzad E, Bouchard A, Moher D, Rody K, Shea B . Cigarette smoking and peripheral arterial occlusive disease . Surgery . 114 . 4 . 753–6; discussion 756–7 . October 1993 . 8211690 .
  38. Kannel WB, McGee DL . Diabetes and glucose tolerance as risk factors for cardiovascular disease: the Framingham study . Diabetes Care . 2 . 2 . 120–126 . 1979 . 520114 . 10.2337/diacare.2.2.120 . 39307266 .
  39. Creager MA, Lüscher TF, Cosentino F, Beckman JA . Diabetes and vascular disease: pathophysiology, clinical consequences, and medical therapy: Part I . Circulation . 108 . 12 . 1527–1532 . September 2003 . 14504252 . 10.1161/01.cir.0000091257.27563.32 . free .
  40. Lüscher TF, Creager MA, Beckman JA, Cosentino F . Diabetes and vascular disease: pathophysiology, clinical consequences, and medical therapy: Part II . Circulation . 108 . 13 . 1655–1661 . September 2003 . 14517152 . 10.1161/01.cir.0000089189.70578.e2 . free .
  41. Beks PJ, Mackaay AJ, de Neeling JN, de Vries H, Bouter LM, Heine RJ . Peripheral arterial disease in relation to glycaemic level in an elderly Caucasian population: the Hoorn study . Diabetologia . 38 . 1 . 86–96 . January 1995 . 7744233 . 10.1007/s001250050257 .
  42. Baigent C, Keech A, Kearney PM, Blackwell L, Buck G, Pollicino C, Kirby A, Sourjina T, Peto R, Collins R, Simes R . 6 . Efficacy and safety of cholesterol-lowering treatment: prospective meta-analysis of data from 90,056 participants in 14 randomised trials of statins . Lancet . 366 . 9493 . 1267–1278 . October 2005 . 16214597 . 10.1016/s0140-6736(05)67394-1 . 10716362 .
  43. Kannel WB, McGee DL . Update on some epidemiologic features of intermittent claudication: the Framingham Study . Journal of the American Geriatrics Society . 33 . 1 . 13–18 . January 1985 . 3965550 . 10.1111/j.1532-5415.1985.tb02853.x . 13543458 .
  44. Ridker PM, Stampfer MJ, Rifai N . Novel risk factors for systemic atherosclerosis: a comparison of C-reactive protein, fibrinogen, homocysteine, lipoprotein(a), and standard cholesterol screening as predictors of peripheral arterial disease . JAMA . 285 . 19 . 2481–2485 . May 2001 . 11368701 . 10.1001/jama.285.19.2481 .
  45. TASC II Guidelines
    * Norgren L, Hiatt WR, Dormandy JA, Nehler MR, Harris KA, Fowkes FG, Bell K, Caporusso J, Durand-Zaleski I, Komori K, Lammer J, Liapis C, Novo S, Razavi M, Robbs J, Schaper N, Shigematsu H, Sapoval M, White C, White J, Clement D, Creager M, Jaff M, Mohler E, Rutherford RB, Sheehan P, Sillesen H, Rosenfield K . 6 . Inter-Society Consensus for the Management of Peripheral Arterial Disease (TASC II) . European Journal of Vascular and Endovascular Surgery . 33 . Suppl 1 . S1-75 . 2007 . 17140820 . 10.1016/j.ejvs.2006.09.024 . Robert B. . free .
    * Norgren L, Hiatt WR, Dormandy JA, Nehler MR, Harris KA, Fowkes FG . Inter-Society Consensus for the Management of Peripheral Arterial Disease (TASC II) . Journal of Vascular Surgery . 45 . Suppl S . S5-67 . January 2007 . 17223489 . 10.1016/j.jvs.2006.12.037 . free .
    * Norgren L, Hiatt WR, Dormandy JA, Nehler MR, Harris KA, Fowkes FG, Rutherford RB . Inter-society consensus for the management of peripheral arterial disease . International Angiology . 26 . 2 . 81–157 . June 2007 . 17489079 . William R. Hiatt .
  46. Serrano Hernando FJ, Martín Conejero A . [Peripheral artery disease: pathophysiology, diagnosis and treatment] . Revista Espanola de Cardiologia . 60 . 9 . 969–982 . September 2007 . 17915154 . 10.1157/13109651 . 71164825 .
  47. Krishna SM, Moxon JV, Golledge J . A review of the pathophysiology and potential biomarkers for peripheral artery disease . International Journal of Molecular Sciences . 16 . 5 . 11294–11322 . May 2015 . 25993296 . 4463701 . 10.3390/ijms160511294 . free .
  48. Book: Rosen's Emergency Medicine: Concepts and Clinical Practice . 9th . Walls R, Hockberger R, Gausche-Hill M . Elsevier, Inc.. 18 May 2017. 9780323354790. Chapter 41, pgs 435–444.
  49. Aboyans V, Criqui MH, Abraham P, Allison MA, Creager MA, Diehm C, Fowkes FG, Hiatt WR, Jönsson B, Lacroix P, Marin B, McDermott MM, Norgren L, Pande RL, Preux PM, Stoffers HE, Treat-Jacobson D . 6 . Measurement and interpretation of the ankle-brachial index: a scientific statement from the American Heart Association . Circulation . 126 . 24 . 2890–2909 . December 2012 . 23159553 . 10.1161/CIR.0b013e318276fbcb . 45644292 . free .
  50. Vowden P, Vowden K. March 2001. Doppler assessment and ABPI: Interpretation in the management of leg ulceration. live. Worldwide Wounds. https://web.archive.org/web/20080509190651/http://www.worldwidewounds.com/2001/march/Vowden/Doppler-assessment-and-ABPI.html. May 9, 2008. mdy-all. – describes ABI procedure, interpretation of results, and notes the somewhat arbitrary selection of "ABI of 0.8 has become the accepted endpoint for high-compression therapy, the trigger for referral for a vascular surgical opinion and the defining upper marker for an ulcer of mixed aetiology.
  51. Amini A, Gordon I, Wilson S, Williams RA . Noncompressible arteries correlate with increased cardiovascular mortality at 2 years . Annals of Vascular Surgery . 27 . 7 . 918–923 . October 2013 . 23993108 . 10.1016/j.avsg.2013.01.006 .
  52. Met R, Bipat S, Legemate DA, Reekers JA, Koelemay MJ . Diagnostic performance of computed tomography angiography in peripheral arterial disease: a systematic review and meta-analysis . JAMA . 301 . 4 . 415–424 . January 2009 . 19176443 . 10.1001/jama.301.4.415 . 44960635 .
  53. Shwaiki O, Rashwan B, Fink MA, Kirksey L, Gadani S, Karuppasamy K, Melzig C, Thompson D, D'Amico G, Rengier F, Partovi S . 6 . Lower extremity CT angiography in peripheral arterial disease: from the established approach to evolving technical developments . The International Journal of Cardiovascular Imaging . 37 . 10 . 3101–3114 . October 2021 . 33997924 . 10.1007/s10554-021-02277-1 . 234684675 .
  54. Leiner T, Kessels AG, Nelemans PJ, Vasbinder GB, de Haan MW, Kitslaar PE, Ho KY, Tordoir JH, van Engelshoven JM . 6 . Peripheral arterial disease: comparison of color duplex US and contrast-enhanced MR angiography for diagnosis . Radiology . 235 . 2 . 699–708 . May 2005 . 15858107 . 10.1148/radiol.2352040089 .
  55. Leiner T . Magnetic resonance angiography of abdominal and lower extremity vasculature . Topics in Magnetic Resonance Imaging . 16 . 1 . 21–66 . February 2005 . 16314696 . 10.1097/01.rmr.0000185431.50535.d7 . 8026674 . free .
  56. Norgren L, Hiatt WR, Dormandy JA, Nehler MR, Harris KA, Fowkes FG, Bell K, Caporusso J, Durand-Zaleski I, Komori K, Lammer J, Liapis C, Novo S, Razavi M, Robbs J, Schaper N, Shigematsu H, Sapoval M, White C, White J, Clement D, Creager M, Jaff M, Mohler E, Rutherford RB, Sheehan P, Sillesen H, Rosenfield K . 6 . Inter-Society Consensus for the Management of Peripheral Arterial Disease (TASC II) . European Journal of Vascular and Endovascular Surgery . 33 . Suppl 1 . S1-75 . 2007 . 17140820 . 10.1016/j.ejvs.2006.09.024 . free . Kevin . Joseph .
  57. Fontaine R, Kim M, Kieny R . [Surgical treatment of peripheral circulation disorders] . de . Helvetica Chirurgica Acta . 21 . 5–6 . 499–533 . December 1954 . 14366554 .
  58. Rutherford RB, Baker JD, Ernst C, Johnston KW, Porter JM, Ahn S, Jones DN . Recommended standards for reports dealing with lower extremity ischemia: revised version . Journal of Vascular Surgery . 26 . 3 . 517–538 . September 1997 . 9308598 . 10.1016/S0741-5214(97)70045-4 . free .
  59. Teraa M, Conte MS, Moll FL, Verhaar MC . Critical Limb Ischemia: Current Trends and Future Directions . Journal of the American Heart Association . 5 . 2 . e002938 . February 2016 . 26908409 . 4802465 . 10.1161/JAHA.115.002938 .
  60. Mills JL, Conte MS, Armstrong DG, Pomposelli FB, Schanzer A, Sidawy AN, Andros G . The Society for Vascular Surgery Lower Extremity Threatened Limb Classification System: risk stratification based on wound, ischemia, and foot infection (WIfI) . Journal of Vascular Surgery . 59 . 1 . 220–234.e1–2 . January 2014 . 24126108 . 10.1016/j.jvs.2013.08.003 . free .
  61. Curry SJ, Krist AH, Owens DK, Barry MJ, Caughey AB, Davidson KW, Doubeni CA, Epling JW, Kemper AR, Kubik M, Landefeld CS, Mangione CM, Silverstein M, Simon MA, Tseng CW, Wong JB . 6 . Screening for Peripheral Artery Disease and Cardiovascular Disease Risk Assessment With the Ankle-Brachial Index: US Preventive Services Task Force Recommendation Statement . JAMA . 320 . 2 . 177–183 . July 2018 . 29998344 . 10.1001/jama.2018.8357 . free .
  62. Alahdab F, Wang AT, Elraiyah TA, Malgor RD, Rizvi AZ, Lane MA, Prokop LJ, Montori VM, Conte MS, Murad MH . 6 . A systematic review for the screening for peripheral arterial disease in asymptomatic patients . English . Journal of Vascular Surgery . 61 . 3 Suppl . 42S–53S . March 2015 . 25721066 . 10.1016/j.jvs.2014.12.008 . free .
  63. Souza . Julio . Escadas . Sara . Baxevani . Isidora . Rodrigues . Daniel . Freitas . Alberto . January 2022 . Smart Wearable Systems for the Remote Monitoring of Selected Vascular Disorders of the Lower Extremity: A Systematic Review . International Journal of Environmental Research and Public Health . en . 19 . 22 . 15231 . 10.3390/ijerph192215231 . 36429951 . 9690814 . 1660-4601 . free .
  64. Oxygenation and flow in the limbs: Novel methods to characterize peripheral artery disease . Curr Cardiovasc Imaging Rep . 2013 . 6 . 2 . 157. 3597748 . Lopez . D. . Kramer . C. M. . 10.1007/s12410-013-9191-7 . 23504569 .
  65. Book: Nichols, Scott . Long-Term in Vivo Oxygen Sensors for Peripheral Artery Disease Monitoring . Oxygen Transport to Tissue XL . 2019 . Adv Exp Med Biol . 1072 . 351–356 . 10.1007/978-3-319-91287-5_56 . 30178370 . 6367927 . 978-3-319-91285-1 .
  66. Profusa Receives CE Mark Approval to Market the Wireless Lumee® Oxygen Platform for Continuous, Real-Time Monitoring of Tissue Oxygen . 2023-09-02 . www.prnewswire.com . en.
  67. 10.1097/HCO.0000000000000597 . COMPASS for Vascular Surgeons . 2019 . Hussain . Mohamad A. . Wheatcroft . Mark . Nault . Patrice . Lindsay . Thomas F. . Bhatt . Deepak L. . Anand . Sonia S. . Verma . Subodh . Al-Omran . Mohammed . Current Opinion in Cardiology . 34 . 2 . 178–184 . 30543542 . 56484366 .
  68. Broderick C, Forster R, Abdel-Hadi M, Salhiyyah K . Pentoxifylline for intermittent claudication . The Cochrane Database of Systematic Reviews . 2020 . 10 . CD005262 . October 2020 . 33063850 . 8094235 . 10.1002/14651858.CD005262.pub4 .
  69. Mills JL, Conte MS, Armstrong DG, Pomposelli FB, Schanzer A, Sidawy AN, Andros G . The Society for Vascular Surgery Lower Extremity Threatened Limb Classification System: risk stratification based on wound, ischemia, and foot infection (WIfI) . Journal of Vascular Surgery . 59 . 1 . 220–34.e1–2 . January 2014 . 24126108 . 10.1016/j.jvs.2013.08.003 . free .
  70. Fowkes FG, Gillespie IN . Angioplasty (versus non surgical management) for intermittent claudication . The Cochrane Database of Systematic Reviews . 2 . CD000017 . 2000 . 10796469 . 10.1002/14651858.CD000017 . Fowkes G .
  71. Johnston KW, Rae M, Hogg-Johnston SA, Colapinto RF, Walker PM, Baird RJ, Sniderman KW, Kalman P . 6 . 5-year results of a prospective study of percutaneous transluminal angioplasty . Annals of Surgery . 206 . 4 . 403–413 . October 1987 . 2959214 . 1493220 . 10.1097/00000658-198710000-00002 .
  72. Emmerich J . Current state and perspective on medical treatment of critical leg ischemia: gene and cell therapy . The International Journal of Lower Extremity Wounds . 4 . 4 . 234–241 . December 2005 . 16286375 . 10.1177/1534734605283538 . 18384741 .
  73. Chowdhury MM, McLain AD, Twine CP . Angioplasty versus bare metal stenting for superficial femoral artery lesions . The Cochrane Database of Systematic Reviews . 2014 . 6 . CD006767 . June 2014 . 24959692 . 6544814 . 10.1002/14651858.CD006767.pub3 .
  74. Wardle BG, Ambler GK, Radwan RW, Hinchliffe RJ, Twine CP . Atherectomy for peripheral arterial disease . The Cochrane Database of Systematic Reviews . 2020 . 9 . CD006680 . September 2020 . 32990327 . 8513671 . 10.1002/14651858.CD006680.pub3 . 222151812 .
  75. Health . Center for Devices and Radiological . 2021-02-26 . Shockwave Intravascular Lithotripsy (IVL) System with the Shockwave C2 Coronary Intravascular Lithotripsy (IVL) Catheter – P200039 . FDA . en.
  76. Rooke TW, Hirsch AT, Misra S, Sidawy AN, Beckman JA, Findeiss L, Golzarian J, Gornik HL, Jaff MR, Moneta GL, Olin JW, Stanley JC, White CJ, White JV, Zierler RE . 6 . Management of patients with peripheral artery disease (compilation of 2005 and 2011 ACCF/AHA Guideline Recommendations): a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines . Journal of the American College of Cardiology . 61 . 14 . 1555–1570 . April 2013 . 23473760 . 4492473 . 10.1016/j.jacc.2013.01.004 .
  77. Rooke TW, Hirsch AT, Misra S, Sidawy AN, Beckman JA, Findeiss LK, Golzarian J, Gornik HL, Halperin JL, Jaff MR, Moneta GL, Olin JW, Stanley JC, White CJ, White JV, Zierler RE . 6 . 2011 ACCF/AHA Focused Update of the Guideline for the Management of Patients With Peripheral Artery Disease (updating the 2005 guideline): a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines . Journal of the American College of Cardiology . 58 . 19 . 2020–2045 . November 2011 . 21963765 . 4714326 . 10.1016/j.jacc.2011.08.023 .
  78. Shammas NW . Epidemiology, classification, and modifiable risk factors of peripheral arterial disease . Vascular Health and Risk Management . 3 . 2 . 229–234 . 2007 . 17580733 . 1994028 . 10.2147/vhrm.2007.3.2.229 . free .
  79. Burns P, Gough S, Bradbury AW . Management of peripheral arterial disease in primary care . BMJ . 326 . 7389 . 584–588 . March 2003 . 12637405 . 1125476 . 10.1136/bmj.326.7389.584 .
  80. Chan KA, Junia A . Lower extremity peripheral artery disease: a basic approach . British Journal of Hospital Medicine . 81 . 3 . 1–9 . March 2020 . 32240007 . 10.12968/hmed.2019.0263 . Mark Allen Group . 214771540 .
  81. Horváth L, Németh N, Fehér G, Kívés Z, Endrei D, Boncz I . Epidemiology of Peripheral Artery Disease: Narrative Review . Life . 12 . 7 . 1041 . July 2022 . 35888129 . 9320565 . 10.3390/life12071041 . 2022Life...12.1041H . free .
  82. Selvin E, Erlinger TP . Prevalence of and risk factors for peripheral arterial disease in the United States: results from the National Health and Nutrition Examination Survey, 1999-2000 . Circulation . 110 . 6 . 738–743 . August 2004 . 15262830 . 10.1161/01.CIR.0000137913.26087.F0 . free .
  83. Bauersachs R, Zeymer U, Brière JB, Marre C, Bowrin K, Huelsebeck M . Burden of Coronary Artery Disease and Peripheral Artery Disease: A Literature Review . Cardiovascular Therapeutics . 2019 . 8295054 . 2019-11-26 . 32099582 . 7024142 . 10.1155/2019/8295054 . free .
  84. Selvin E, Wattanakit K, Steffes MW, Coresh J, Sharrett AR . HbA1c and peripheral arterial disease in diabetes: the Atherosclerosis Risk in Communities study . Diabetes Care . 29 . 4 . 877–882 . April 2006 . 16567831 . 10.2337/diacare.29.04.06.dc05-2018 . live . free . mdy-all . https://web.archive.org/web/20120304010446/http://care.diabetesjournals.org/content/29/4/877.long . March 4, 2012 .
  85. Suzuki J, Shimamura M, Suda H, Wakayama K, Kumagai H, Ikeda Y, Akazawa H, Isobe M, Komuro I, Morishita R . 6 . Current therapies and investigational drugs for peripheral arterial disease . Hypertension Research . 39 . 4 . 183–191 . April 2016 . 26631852 . 10.1038/hr.2015.134 . 3070349 .
  86. Moazzami B, Mohammadpour Z, Zabala ZE, Farokhi E, Roohi A, Dolmatova E, Moazzami K . Local intramuscular transplantation of autologous bone marrow mononuclear cells for critical lower limb ischaemia . The Cochrane Database of Systematic Reviews . 2022 . 7 . CD008347 . July 2022 . 35802393 . 9266992 . 10.1002/14651858.CD008347.pub4 .
  87. Adam DJ, Beard JD, Cleveland T, Bell J, Bradbury AW, Forbes JF, Fowkes FG, Gillepsie I, Ruckley CV, Raab G, Storkey H . 6 . Bypass versus angioplasty in severe ischaemia of the leg (BASIL): multicentre, randomised controlled trial . Lancet . 366 . 9501 . 1925–1934 . December 2005 . 16325694 . 10.1016/S0140-6736(05)67704-5 . 54229954 .
  88. Conte MS . Bypass versus Angioplasty in Severe Ischaemia of the Leg (BASIL) and the (hoped for) dawn of evidence-based treatment for advanced limb ischemia . Journal of Vascular Surgery . 51 . 5 Suppl . 69S–75S . May 2010 . 20435263 . 10.1016/j.jvs.2010.02.001 . free .
  89. Menard MT, Farber A, Assmann SF, Choudhry NK, Conte MS, Creager MA, Dake MD, Jaff MR, Kaufman JA, Powell RJ, Reid DM, Siami FS, Sopko G, White CJ, Rosenfield K . 6 . Design and Rationale of the Best Endovascular Versus Best Surgical Therapy for Patients With Critical Limb Ischemia (BEST-CLI) Trial . Journal of the American Heart Association . 5 . 7 . e003219 . July 2016 . 27402237 . 5015366 . 10.1161/JAHA.116.003219 .
  90. Popplewell MA, Davies H, Jarrett H, Bate G, Grant M, Patel S, Mehta S, Andronis L, Roberts T, Deeks J, Bradbury A . 6 . Bypass versus angio plasty in severe ischaemia of the leg - 2 (BASIL-2) trial: study protocol for a randomised controlled trial . Trials . 17 . 11 . January 2016 . 26739146 . 4704263 . 10.1186/s13063-015-1114-2 . free .
  91. News: Gene Therapy for PAD Approved. 5 August 2015. 6 December 2011. live. https://web.archive.org/web/20150903230011/http://www.dddmag.com/news/2011/12/gene-therapy-pad-approved. September 3, 2015. mdy-all.
  92. Deev RV, Bozo IY, Mzhavanadze ND, Voronov DA, Gavrilenko AV, Chervyakov YV, Staroverov IN, Kalinin RE, Shvalb PG, Isaev AA . 6 . pCMV-vegf165 Intramuscular Gene Transfer is an Effective Method of Treatment for Patients With Chronic Lower Limb Ischemia . Journal of Cardiovascular Pharmacology and Therapeutics . 20 . 5 . 473–482 . September 2015 . 25770117 . 10.1177/1074248415574336 . 13443907 .

This article is licensed under the GNU Free Documentation License. It uses material from the Wikipedia article "Peripheral artery disease".

Except where otherwise indicated, Everything.Explained.Today is © Copyright 2009-2024, A B Cryer, All Rights Reserved. Cookie policy.