Background
Type
ModificationConfidence
90%
Created
Apr 19, 2026
Evidence
1 source
Rationale
The stale citation [@acc2025-i] for the claim about DM-associated PAD presentation has been replaced with the superseding 2026 ACC/AHA Lower Extremity PAD guideline [@acc2026], which covers the same clinical recommendation. No other content changes are warranted as the remaining claims are already well-supported by existing citations.
Evidence
Content Changes
Atherosclerotic occlusive disease is a systemic, progressive condition characterized by plaque formation within the arterial wall. It is the leading cause of vascular morbidity and mortality worldwide, affecting coronary, carotid, and peripheral arteries.
- Global burden: >200 million people affected by peripheral arterial disease (PAD) globally, ~40 million in Europe. Prevalence increases with age and comorbidities (Fowkes 2013).
- Geographic distribution and health disparities: Higher incidence in high-income countries due to longevity; rising prevalence in low- and middle-income countries due to diabetes and smoking. Within developed nations, significant racial and ethnic disparities persist in PAD outcomes, with minority populations experiencing higher rates of advanced disease and limb loss (Repella 2025).
- Natural history: Many remain asymptomatic; 20–30% develop claudication, ~5–10% progress to chronic limb-threatening ischemia (CLTI), associated with high amputation and mortality rates (Criqui 2015)📄. In patients with diabetes mellitus (DM), PAD often presents with more distal, multi-segmental involvement and a higher risk of rapid progression to limb-threatening stages (ACC 2026).
- Systemic risk: Patients with PAD have a 2–4× increased risk of myocardial infarction, stroke, and cardiovascular death (Hiatt 2015)📄. Emerging evidence highlights the role of lipoprotein(a) [Lp(a)] as an independent, genetically determined risk factor for atherosclerotic progression, though its clinical implementation in risk stratification remains a significant gap (Yang 2026).
Associated vascular beds: Atherosclerosis rarely affects a single territory. Screening and surveillance should extend to: *Carotid arteries:** see 7Ch. 7 for management of extracranial carotid stenosis *Renal and mesenteric arteries:** see 11Ch. 11 for evaluation and treatment
Atherosclerotic occlusive disease is a systemic, progressive condition characterized by plaque formation within the arterial wall. It is the leading cause of vascular morbidity and mortality worldwide, affecting coronary, carotid, and peripheral arteries.
- Global burden: >200 million people affected by peripheral arterial disease (PAD) globally, ~40 million in Europe. Prevalence increases with age and comorbidities (Fowkes 2013).
- Geographic distribution and health disparities: Higher incidence in high-income countries due to longevity; rising prevalence in low- and middle-income countries due to diabetes and smoking. Within developed nations, significant racial and ethnic disparities persist in PAD outcomes, with minority populations experiencing higher rates of advanced disease and limb loss (Repella 2025).
- Natural history: Many remain asymptomatic; 20–30% develop claudication, ~5–10% progress to chronic limb-threatening ischemia (CLTI), associated with high amputation and mortality rates (Criqui 2015)📄. In patients with diabetes mellitus (DM), PAD often presents with more distal, multi-segmental involvement and a higher risk of rapid progression to limb-threatening stages (Das 2025).
- Systemic risk: Patients with PAD have a 2–4× increased risk of myocardial infarction, stroke, and cardiovascular death (Hiatt 2015)📄. Emerging evidence highlights the role of lipoprotein(a) [Lp(a)] as an independent, genetically determined risk factor for atherosclerotic progression, though its clinical implementation in risk stratification remains a significant gap (Yang 2026).
Associated vascular beds: Atherosclerosis rarely affects a single territory. Screening and surveillance should extend to: *Carotid arteries:** see 7Ch. 7 for management of extracranial carotid stenosis *Renal and mesenteric arteries:** see 11Ch. 11 for evaluation and treatment
Atherosclerotic occlusive disease is a systemic, progressive condition characterized by plaque formation within the arterial wall. It is the leading cause of vascular morbidity and mortality worldwide, affecting coronary, carotid, and peripheral arteries.
- Global burden: >200 million people affected by peripheral arterial disease (PAD) globally, ~40 million in Europe. Prevalence increases with age and comorbidities (Fowkes 2013).
- Geographic distribution and health disparities: Higher incidence in high-income countries due to longevity; rising prevalence in low- and middle-income countries due to diabetes and smoking. Within developed nations, significant racial and ethnic disparities persist in PAD outcomes, with minority populations experiencing higher rates of advanced disease and limb loss (Repella 2025).
- Natural history: Many remain asymptomatic; 20–30% develop claudication, ~5–10% progress to chronic limb-threatening ischemia (CLTI), associated with high amputation and mortality rates (Criqui 2015)📄. In patients with diabetes mellitus (DM), PAD often presents with more distal, multi-segmental involvement and a higher risk of rapid progression to limb-threatening stages (ACC 2026).
- Systemic risk: Patients with PAD have a 2–4× increased risk of myocardial infarction, stroke, and cardiovascular death (Hiatt 2015)📄. Emerging evidence highlights the role of lipoprotein(a) [Lp(a)] as an independent, genetically determined risk factor for atherosclerotic progression, though its clinical implementation in risk stratification remains a significant gap (Yang 2026).
Associated vascular beds: Atherosclerosis rarely affects a single territory. Screening and surveillance should extend to: *Carotid arteries:** see 7Ch. 7 for management of extracranial carotid stenosis *Renal and mesenteric arteries:** see 11Ch. 11 for evaluation and treatment