PERIPHERAL ARTERIAL DISEASE
Peripheral arterial disease (PAD) is a progressive narrowing and degeneration of the
arteries of the neck, abdomen, and extremities. In most cases, it is a result of
PAD typically appears in the sixth to eighth decades of life. It occurs at an earlier age in
persons with diabetes mellitus and more frequently in African Americans.
The four most significant risk factors for PAD are cigarette smoking (most important),
hyperlipidemia, hypertension, and diabetes mellitus.
The most common locations for PAD are the coronary arteries, carotid arteries, aortic
bifurcation, iliac and common femoral arteries, profunda femoris artery, superficial
femoral artery, and distal popliteal artery.
Aortic aneurysms are outpouchings or dilations of the arterial wall.
The primary causes of aortic aneurysms can be classified as degenerative, congenital,
mechanical, inflammatory, or infectious.
Aortic aneurysms may involve the aortic arch, thoracic aorta, and/or abdominal aorta, but
most are found in the abdominal aorta below the level of the renal arteries.
Thoracic aorta aneurysms are often asymptomatic, but the most common manifestations
are deep, diffuse chest pain that may extend to the interscapular area; hoarseness as a
result of pressure on the recurrent laryngeal nerve; and dysphagia from pressure on the
Abdominal aortic aneurysms (AAAs) are often asymptomatic but symptoms may mimic
pain associated with abdominal or back disorders.
The most serious complication related to an untreated aneurysm is rupture and bleeding.
Diagnostic tests for AAAs include chest x-ray, electrocardiogram (to rule out myocardial
infarction), echocardiography, CT scan, and magnetic resonance imaging scan.
The goal of management is to prevent the aneurysm from rupturing.
Surgical repair of AAA involves (1) incising the diseased segment of the aorta, (2)
removing intraluminal thrombus or plaque, (3) inserting a synthetic graft, and (4) suturing
the native aortic wall around the graft. Minimally invasive endovascular grafting is an alternative to conventional surgical repair
of AAA and involves the placement of a sutureless aortic graft into the abdominal aorta
inside the aneurysm via a femoral artery cutdown.
Preoperatively, the patient is monitored for indications of aneurysm rupture.