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The ESC Textbook of Cardiovascular Medicine$
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The ESC Textbook of Cardiovascular Medicine (2 ed.)

Edited by A. John Camm, Thomas F. Lüscher, Patrick W. Serruys

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Publisher:
Oxford University Press
Print Publication Date:
Aug 2009
Print ISBN-13:
9780199566990
Published to Oxford Medicine:
Aug 2009
DOI:
10.1093/med/9780199566990.001.0001
© European Society of Cardiology

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Oxford University Press makes no representation, express or implied, that the drug dosages in this book are correct. Readers must therefore always check the product information and clinical procedures with the most up to date published product information and data sheets provided by the manufacturers and the most recent codes of conduct and safety regulations. The authors and the publishers do not accept responsibility or legal liability for any errors in the text or for the misuse or misapplication of material in this work. Except where otherwise stated, drug dosages and recommendations are for the non-pregnant adult who is not breastfeeding.

Contents

Peripheral Arterial Occlusive Disease

Chapter:
Peripheral Arterial Occlusive Disease
DOI:
10.1093/med/9780199566990.003.036

Peripheral arterial occlusive disease (PAD) is a disorder of the peripheral arteries comprising all human arterial beds except for the coronary circulation. The interest in detection and dedicated treatment options for PAD patients has increased substantially during recent years. Given that PAD is a powerful indicator of systemic atherosclerosis and, independent of symptoms, is associated with an increased risk of myocardial infarction and stroke as well as a six times greater likelihood of death, the prevalence and demographic distribution of measurable PAD becomes relevant.

The management of patients with PAD—wherever the disease is located—has to be planned in the context of natural history, epidemiology of disease, risk factors predicting deterioration, and clinical presentation. Setting the correct indication for different treatment options (medical, endovascular, surgical, hybrid) in patients affected by PAD is a condition where the principles of multi-disciplinary integration between all the specialties involved in that specific field find a paradigmatic application.

An objective evaluation of benefits and risks related to different therapeutic strategies is still difficult and sometimes controversial. Reliable information on clinical outcome or symptom relief is weak and illustrates discrepancies between published reports of specific treatment from centres of excellence and what happens to patients routinely treated in communities around the world. However, a continuing shift away from surgical revascularization towards the less invasive endovascular procedures for PAD patients is being witnessed. Endovascular interventions have greatly changed the current therapeutic spectrum and many indications such as for renal, pelvic, and femoro-popliteal arteries are today regarded as standard practice. Currently, controversy exists regarding whether carotid artery stenting should be accepted as an alternative to the surgical approach for the treatment of obstructive carotid artery disease.

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