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
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