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Contributed by Mr Stephen G E Barker, senior lecturer in surgery, University College London and honorary consultant vascular surgeon, University College London Hospitals NHS Foundation Trust.
1. EPIDEMIOLOGY AND AETIOLOGY
The peripheral effects of arterial narrowing and occlusion are the cause of significant morbidity and occasional mortality, and a significant drain on the NHS.
The true aetiology of atheromatous plaque formation remains uncertain, but common risk factors are well established: smoking, diabetes, hypertension, raised cholesterol levels, male gender, being aged over 55 and an established family history.
Symptoms will relate directly to whichever large distribution vessels have become narrowed. Hypertension and renal failure may result from narrowing of either of the renal arteries, mesenteric angina - which often manifests as severe abdominal cramps after food - may result from narrowing of the superior mesenteric artery but, most often, lower limb symptoms will relate to narrowing of the iliac or femoral arteries, or the calf vessels.
Intermittent claudication (IC) is described as 'pain on exercise, …