Epidemiology, diagnosis and classification of peripheral artery disease (PAD)

Rahul Chaudhary, Neeraj Shah, Jalaj Garg, Nainesh Patel, Hasan Ahmad

Research output: Chapter in Book/Report/Conference proceedingChapter


Peripheral arterial disease (PAD) affects almost 27 million people in United States and Europe, and most are either asymptomatic or have intermittent claudication (IC). Using objective testing such as the ankle brachial index (ABI), PAD prevalence ranges from 3% to 10% and as high as 20% in patients greater than 70 years of age. Incidence of IC ranges from 3% in patients younger than age 40 to 6% in the older ones. Annual incidence of critical limb ischemia (CLI) is about 200-400 cases per million and nearly 1% of the patients with IC present with CLI each year. The natural course of CLI is dismal with limb loss in more than one third of the patients at the end of 6 months and a mortality rate of 20%. Acute limb ischemia (ALI), is defined as rapid decrease in blood flow resulting in rest pain or gangrene is an emergency and has an incidence of 140 per million per year. Patients with PAD have an increased risk of cardiovascular mortality, coronary artery disease, stroke and all-cause mortality. Ankle brachial index (ABI) is used to detect the severity of PAD, with lower values indicating more severe disease. Arterial duplex is a valuable noninvasive test used to detect the location and degree of the blockage in patients with PAD and can play an important role in guiding therapy. However, angiography remains the gold standard to diagnose atherosclerosis in the peripheral arteries. Clinical classification of PAD is based on presence of symptoms like claudication or rest pain and presence of tissue loss in form of ulceration or gangrene. Fontaine stages of peripheral vascular disease and Rutherford classification are used to classify PAD clinically. Anatomic classification of PAD is based on the Trans-Atlantic InterSociety Consensus (TASC) classification system, which is based on the size and location of the lesion. TASC system divides the lower extremity vessels into 3 divisions: aortoiliac (inflow), femoral-popliteal and infrapopliteal (outflow). Based on the lesion complexity, lesions at each of these sites are further classified into four subgroups (A, B, C, D). In general, for TASC A lesions, endovascular therapy is recommended, for TASC D lesions, surgical therapy is recommended and for types B & C, either therapy can be offered.

Original languageEnglish (US)
Title of host publicationPeripheral Artery Disease (PAD)
Subtitle of host publicationRisk Factors, Diagnosis and Emerging Treatments
PublisherNova Science Publishers, Inc.
Number of pages22
ISBN (Electronic)9781634849036
ISBN (Print)9781634848800
StatePublished - Jan 1 2016
Externally publishedYes


  • Classification of PAD
  • Diagnosis of PAD
  • Peripheral arterial disease (PAD)

ASJC Scopus subject areas

  • General Medicine


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