Arterial Occlusive Diseases of the Extremities

  • Alan T. Hirsch


The arterial occlusive diseases of the lower extremities represent a spectrum of disorders encompassing myriad etiologies. The normal “end-organ” functions of the lower and upper extremities are (1) to permit independent ambulation, and (2) to manipulate objects; thus, diseases that alter normal limb function may potentially elicit major disabilities. Although the most common cause of lower extremity arterial occlusive disease in Western societies remains atherosclerosis, other disorders may perturb normal limb perfusion. The extremity arteries are susceptible to congenital, inflammatory, and degenerative diseases, including fibromuscular dysplasia, thromboangiitis obliterans (Buerger’s disease), vascular entrapment syndromes, and both arterial thromboembolism and atheroembolism. The consideration of a broad differential diagnosis is essential for establishing an effective diagnostic and individualized treatment plan.


Peripheral Arterial Disease Patency Rate Popliteal Artery Critical Limb Ischemia Intermittent Claudication 
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  1. 1.
    Criqui MH, Fronek A, Barrett-Connor E, et al.: The prevalence of peripheral arterial disease in a defined population. Circulation 1985, 1:510–515.Google Scholar
  2. 2.
    TransAtlantic Inter-Society Consensus (TASC). Management of peripheral arterial disease. J Vasc Surg 2000, 31 (1): S9.Google Scholar
  3. 3.
    Newman AB, Siscovick DS, Manolio TA, et al.: Ankle-arm index as a marker of atherosclerosis in the Cardiovascular Health Study. Circulation 1993, 88:837–845.Google Scholar
  4. 4.
    Kannel WB, Wolf PA, Garrison RJ, eds: The Framingham Study: an epidemiologic investigation of cardiovascular disease, Section 34. National Technical Information Service, 1987, NIH publication No. 87–2703.Google Scholar
  5. 5.
    Strandness DE, Zierler RE: Exercise ankle pressure measurements in arterial disease. In Noninvasive Diagnostic Techniques in Vascular Disease, edn 3. Edited by Bernstein EF. St. Louis: Mosby; 1985: 575–583.Google Scholar
  6. 6.
    Hirsch AT, Rooke TW: Peripheral vascular diseases. In Cardiovascular Medicine, edn 2. Edited by Cohn JN, Willerson JT. New York: Churchill-Livingstone; 2000: 1398–1416.Google Scholar
  7. 7.
    Weitz JI, Byrne J, Clagett P, et al.: Diagnosis and treatment of chronic arterial insufficiency of the lower extremities: a critical review. Circulation 1996, 94:3026–3049.Google Scholar
  8. 8.
    McDaniel MD, Cronenwett JL: Basic data related to the natural history of intermittent claudication. Ann Vasc Surg 1989, 3: 273–277.PubMedCrossRefGoogle Scholar
  9. 9.
    Vogt MT, Cauley JA, Newman AB, et al.: Decreased ankle arm blood pressure index and mortality in elderly women. JAMA 1993, 270:465–469.Google Scholar
  10. 10.
    Newman AB, Sutton-Tyrrell K, Vogt MT, Kuller LH: Morbidity and mortality in hypertensive adults with a low ankle arm blood pressure index. JAMA 1993, 270: 487–489.PubMedCrossRefGoogle Scholar
  11. 11.
    McKenna M, Wolfson S, Kuller L: The ratio of ankle and arm blood pressure as an independent risk factor of mortality. Atherosclerosis 1991, 87: 119–128.PubMedCrossRefGoogle Scholar
  12. 12.
    Hirsch AT, Criqui MH, Treat-Jacobson D, et al.: Peripheral arterial disease, detection, awareness, and treatment in primary care. ’AMA 2001, 286:1317–1324.Google Scholar
  13. 13.
    National Cholesterol Education Program. Second Report of the Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel II). Circulation 1994, 89 (3): 1333–1445.Google Scholar
  14. 14.
    Kannel WB: Risk factors for atherosclerotic cardiovascular outcomes in different arterial territories. J Cardiovasc Risk 1994, 1 (4): 333–339.PubMedCrossRefGoogle Scholar
  15. 15.
    Wilterdink JL, Easton JD: Vascular event rates in patients with atherosclerotic cerebrovascular disease. Arch Neurol 1992, 49 (8): 857–863.PubMedCrossRefGoogle Scholar
  16. 16.
    Criqui MH, Langer RD, Fronek A, et al.: Mortality over a period of 10 years in patients with peripheral arterial disease. N Engl J Med 1992, 326(6):381–386.Google Scholar
  17. 17.
    Barndt R, Blankenhorn DH, Crawford DW, Brooks SH: Regression and progression of early femoral atherosclerosis in treated hyperlipoproteinemic patients. Ann Intern Med 1977, 86: 139–146.PubMedCrossRefGoogle Scholar
  18. 18.
    Buchwald H, Varco RL, Matts JP, et al.: Effect of partial ileal bypass on mortality and morbidity from coronary heart disease in patients with hypercholesterolemia: report of the Program on the Surgical Control of the Hyperlipidemias. N Engl J Med 1990, 323:946.Google Scholar
  19. 19.
    Pedersen TR, Kjekshus J, Pyorala K, et al.: Effect of simvastatin on ischemic signs and symptoms in the Scandinavian simvastatin survival study (4S). Am J Cardiol 1998, 81:333–335.Google Scholar
  20. 20.
    Executive Summary of The Third Report of the National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III). ’AMA 2001, 285: 2486–2497.Google Scholar
  21. 21.
    Jonason T, Bergstrom R: Cessation of smoking in patients with intermittent claudication: effects on the risk of peripheral vascular complications, myocardial infarction and mortality. Acta Med Scand 1987, 221: 253–260.PubMedCrossRefGoogle Scholar
  22. 22.
    Faulkner KW, House AK, Castleden WM: The effect of cessation of smoking on the accumulative survival rates of patients with symptomatic peripheral vascular disease. Med J Aust 1983, 1: 217–219.PubMedGoogle Scholar
  23. 23.
    Lassila R, Lepantalo M: Cigarette smoking and the outcome after lower limb arterial surgery. Acta Chir Scand 1988, 154: 635–640.PubMedGoogle Scholar
  24. 24.
    De Felice M, Gallo P, Masotti G: Current therapy of peripheral obstructive arterial disease: the nonsurgical approach. Angiology 1990, 41: 1–11.PubMedCrossRefGoogle Scholar
  25. 25.
    Collaborative meta-analysis of randomised trials of antiplatelet therapy for prevention of death, myocardial infarction, and stroke in high-risk patients. Br Med J 2002, 324: 71–86.Google Scholar
  26. 26.
    A randomized, blinded, trial of clopidogrel versus aspirin in patients at risk of ischaemic events (CAPRIE). Lancet 1996, 348: 1329–1339.CrossRefGoogle Scholar
  27. 27.
    Lindgarde F, Jelnes R, Bjorkman H, et al.: Conservative drug treatment in patients with moderately severe chronic occlusive peripheral arterial disease: Scandinavian Study Group. Circulation 1989, 80:1549–1556.Google Scholar
  28. 28.
    Kimura Y, Tani Y, Knabe T, Watanabe K: Effect of cilostazol on platelet aggregation and experimental thrombosis. Arzneimittelforschung 1985, 35: 1144–1149PubMedGoogle Scholar
  29. 29.
    Dawson DL, Cutler BS, Meissner MH, et al.: Cilostazol has beneficial effects in treatment of intermittent claudication: results from a multicenter, randomized, prospective, double-blind trial. Circulation 1998, 98:678–686.Google Scholar
  30. 30.
    Money SR, Herd JA, Isaacsohn JL, et al.: Effect of cilostazol on walking distances in patients with intermittent claudication caused by peripheral vascular disease. J Vasc Surg 1998, 27:267–274.Google Scholar
  31. 31.
    Beebe HG, Dawson DL, Cutler BS, et al.: A new pharmacological treatment for intermittent claudication: results of a randomized, multicenter trial. Arch Intern Med 1999, 159:2041–2050.Google Scholar
  32. 32.
    Dawson DL, Cutler BS, Hiatt WR, et al.: A comparison of cilostazol and pentoxifylline for treating intermittent claudication. Am J Med 2000, 109(17):523–530.Google Scholar
  33. 33.
    Larsen O, Lassen N: Effect of daily muscular exercise in patients with intermittent claudication. Lancet 1966, II: 1093–1096.Google Scholar
  34. 34.
    Hiatt WR: Benefit of exercise conditioning for patients with intermittent claudication. Circulation 1990, 81: 602–609.PubMedCrossRefGoogle Scholar
  35. 35.
    Gardner AW, Poehlman ET: Exercise rehabilitation programs for the treatment of claudication pain. JAMA 1995, 274: 975–980PubMedCrossRefGoogle Scholar
  36. 36.
    Current Procedural Terminology (CPT) 2001. Chicago: American Medical Association; 2001.Google Scholar
  37. 37.
    Bosch JL, Hunink MG: Meta-analysis of the results of percutaneous transluminal angioplasty and stent placement for aortoiliac occlusive disease. Radiology 1997, 204 (1): 87–96.PubMedGoogle Scholar
  38. 38.
    Brewster DC: Clinical and anatomical considerations for surgery in aortoiliac disease and results of surgical treatment. Circulation 1991, 83(suppl I):I-42-I-52.Google Scholar
  39. 39.
    Buerger L: Thromboangiitis obliterans: a study of the vascular lesions leading to pre-senile, spontaneous gangrene. Am J Med Sci 1908, 136: 56.CrossRefGoogle Scholar
  40. 40.
    McPherson JR, Juergens JL, Gifford RW: Thromboangiitis obliterans and arteriosclerosis obliterans: clinical and prognostic differences. Ann Int Med 1963, 59: 288–296.PubMedCrossRefGoogle Scholar
  41. 41.
    Luscher TF, Lie JT, Stanson AW, et al.: Arterial fibromuscular dysplasia. Mayo Clin Proc 1987, 62:931–952.Google Scholar
  42. 42.
    Rutherford RB, Flanigan DP, Gupta SK, et al.: Suggested standards for reports dealing with lower extremity ischemia. J Vasc Surg 1986, 4:80–94.Google Scholar
  43. 43.
    McNamara TO, Fischer JR: Thrombolysis of peripheral arterial and graft occlusions: improved results using high-dose urokinase. Am J Radiol 1985, 144: 169–175.Google Scholar
  44. 44.
    McNamara TO, Bomberger RA: Factors affecting initial and 6-month patency rates after intra-arterial thrombolysis with high dose urokinase. Am J Surg 1986, 152: 709–712.PubMedCrossRefGoogle Scholar
  45. 45.
    Results of a prospective trial evaluating surgery versus thrombolysis for ischemia of the lower extremity. The STILE trial. Ann Surg 1994, 220 (3): 251–268.Google Scholar
  46. 46.
    Ouriel K, Vieth FJ, Sasahra AA: A comparison of recombinant urokinase with vascular surgery as initial treatment for acute arterial occlusion of the legs. Thrombolysis or Peripheral Arterial Surgery (TOPAS) Investigators. N Engl J Med 1998, 338: 1105–1111.PubMedCrossRefGoogle Scholar
  47. 47.
    TransAtlantic Inter-Society Consensus (TASC): Management of peripheral arterial disease. J Vasc Surg 2000, 31 (1): S162.Google Scholar

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© Springer Science+Business Media New York 2003

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  • Alan T. Hirsch

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