الفهرس 
BLOOD VESSELS STRUCTURE ANDOnly 14 pages are availabe for public view
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Abstract
The major cause of lower extremity Peripheral vascular disease is atherosclerosis. Risk factors for atherosclerosis such as cigarette smoking, diabetes, dyslipidemia, hypertension, and hyper-homocysteinemia increase the likelihood of developing lower extremity Peripheral vascular disease. Lower extremity Peripheral vascular disease is a common syndrome that affects a large proportion of most adult populations worldwide.
Peripheral arterial disease can be present in sub-clinical forms that can be detected by use of sensitive vascular imaging techniques, which may reveal early manifestations of arterial disease before it is detected by either limb-pressure measurements or clinical symptoms. When so defined, as, for example, by measurement of the intimal-medial thickness (IMT) in the carotid or femoral artery, early forms of Peripheral vascular disease are easily detected in populations at risk.
Claudication, a symptomatic expression of lower extremity Peripheral vascular disease, defines a significantly smaller subset of the total population with the disease. The prognosis of patients with Peripheral vascular disease is characterized by an increased risk for cardiovascular ischemic events due to concomitant coronary artery disease and cerebro-vascular disease.
These cardiovascular ischemic events are more frequent than ischemic limb events in any lower extremity Peripheral vascular disease cohort, whether individuals present without symptoms or with atypical leg pain, classic claudication, or critical limb ischemia.
Atherosclerosis of peripheral vessels or peripheral vascular disease is the most common cause of symptomatic stenosis in human vascular tree. The pathogenetic mechanisms that lead to peripheral vascular disease are similar to those of coronary artery disease.
Approximately 100 million people have peripheral vascular disease, only one half of whom manifests symptoms. Peripheral vascular disease is the leading cause of limb amputation; the annual rates of limb loss are 2% in non diabetic patients and 7% in diabetic patients. The prevalence of peripheral vascular disease in those older than 65 years is even greater. The most common symptom is pain in one or both legs (claudication), which usually occurs walking. In advanced cases, ulcers or gangrene can develop.
Therapeutic goals for peripheral vascular disease include relief of symptoms and preservation of organs and tissues. Aggressive risk-factor reduction and pharmacologic treatments are the keystones in patient care. Once the affected luminal diameter is compromised by 75% or more, the risk of ischemia and limb loss becomes high. After this point, medical therapy, such as anti platelet and vasodilators, become less effective, and revascularization becomes necessary. In the past, surgical revascularization has been performed with an acceptable risk.
The work of pioneers, such as Dotter and Gruntzig, has opened up a novel era of percutaneous revascularization with techniques such as percutaneous transluminal angioplasty (PTA), a less invasive option in the management of PVD.
Over the past 30 years, PTA has experienced steady growth and recently, it has become the first-line therapy for Peripheral vascular disease. Increased emphasis on containing and reducing the healthcare expenditures has also enhanced the use of PTA (as compared with surgical procedures), which can be performed as a same-day procedure that saves overall costs.
Recent developments in treatment options for peripheral arterial disease have improved the prognosis; more patients survive longer. Newer treatment options for peripheral arterial disease, such as anti-platelet and claudication therapies, have aimed at preventing adverse cardiovascular events, limb loss, and the need for surgical interventions. In addition to these clinical benefits, the same treatment options enhance the quality of life (QOL) for with PAD by helping those live more productive and satisfying lives.
The endovascular treatment of lower-extremity PAD continues to evolve, with the expectation of improvement in acute success rates and safety and the anticipation of improving long-term durability with newer technologies ranging from local drug delivery to bio-absorbable stents. Percutaneous procedures will continue to replace open surgery. The current evidence base to support decision making is quite shallow compared with the field of coronary intervention, and reporting standards for PAD intervention are generally lacking, but there is an increasing resolve on the part of physician investigators, government regulators and payers, and industry to undertake the difficult but necessary task of collecting more definitive data.