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September 19, 2001

Detection of Peripheral Arterial Disease in Primary Care

Author Affiliations

Author Affiliation: Department of Vascular Surgery, Cleveland Clinic Foundation, Cleveland, Ohio.

JAMA. 2001;286(11):1380-1381. doi:10.1001/jama.286.11.1380

Peripheral arterial disease (PAD) encompasses those entities that result in arterial occlusions in vessels other than those of the coronary and intracranial vascular beds. Although PAD includes the extracranial carotid, upper extremity, visceral, and renal circulation, the term is usually applied to disease involving the circulation of the lower extremity alone. Intermittent claudication, heralded by pain in the leg muscles during ambulation, is the earliest and the most classic symptom among patients with PAD.1 As the severity of arterial occlusion progresses, symptoms occur even at rest and may culminate in lower extremity ulceration and gangrene. Major amputation is eventually required in more than one third of patients once such limb-threatening symptoms and signs occur.2 Moreover, all-cause mortality is closely linked with the presence and severity of PAD,3 reaching 20% annually in patients with limb-threatening manifestations.4 Nevertheless, the cause of death in patients with PAD is seldom a direct result of the lower extremity arterial disease. Most patients die from complications of coronary artery disease or cerebrovascular disease, with fewer than 10% of deaths from peripheral vascular events.5