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"documento" => "simple-article" "crossmark" => 1 "subdocumento" => "edi" "cita" => "Med Clin. 2023;161:342-3" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "en" => array:10 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Editorial</span>" "titulo" => "The obesity paradox" "tienePdf" => "en" "tieneTextoCompleto" => "en" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "342" "paginaFinal" => "343" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "La paradoja de la obesidad" ] ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Flora Sánchez-Jiménez, Carlos Jiménez-Cortegana" "autores" => array:2 [ 0 => array:2 [ "nombre" => "Flora" "apellidos" => "Sánchez-Jiménez" ] 1 => array:2 [ "nombre" => "Carlos" "apellidos" => "Jiménez-Cortegana" ] ] ] ] ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0025775323005626?idApp=UINPBA00004N" "url" => "/00257753/0000016100000008/v1_202310180449/S0025775323005626/v1_202310180449/en/main.assets" ] "en" => array:19 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Review</span>" "titulo" => "Peripheral artery disease: Update on etiology, pathophysiology, diagnosis and treatment" "tieneTextoCompleto" => true "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "344" "paginaFinal" => "350" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "Darío Mandaglio-Collados, Francisco Marín, José Miguel Rivera-Caravaca" "autores" => array:3 [ 0 => array:3 [ "nombre" => "Darío" "apellidos" => "Mandaglio-Collados" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 1 => array:3 [ "nombre" => "Francisco" "apellidos" => "Marín" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 2 => array:4 [ "nombre" => "José Miguel" "apellidos" => "Rivera-Caravaca" "email" => array:1 [ 0 => "josemiguel.rivera@um.es" ] "referencia" => array:3 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] 2 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] ] "afiliaciones" => array:2 [ 0 => array:3 [ "entidad" => "Department of Cardiology, Hospital Clínico Universitario Virgen de la Arrixaca, University of Murcia, Instituto Murciano de Investigación Biosanitaria (IMIB-Arrixaca), CIBERCV, Murcia, Spain" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Faculty of Nursing, University of Murcia, Murcia, Spain" "etiqueta" => "b" "identificador" => "aff0010" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Enfermedad arterial periférica: Actualización en etiología, fisiopatología, diagnóstico y tratamiento" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1307 "Ancho" => 3341 "Tamanyo" => 412039 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Thrombus formation and atherosclerotic plaque rupture in peripheral artery disease.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">Peripheral artery disease (PAD) is a common condition defined as a chronic occlusive disease of the major systemic arteries, more commonly in the lower extremities. PAD is a progressive atherosclerotic disease, that is considered an indicator of generalized atherosclerosis.<a class="elsevierStyleCrossRef" href="#bib0290"><span class="elsevierStyleSup">1</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">The clinical manifestations vary from impaired walking, intermittent claudication (the classical hallmark of PAD), and chronic limb-threatening ischaemia (CLTI, the most severe condition resulting in limb loss or even death), although approximately 40% of patients experience no leg symptoms.<a class="elsevierStyleCrossRefs" href="#bib0290"><span class="elsevierStyleSup">1,2</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">The risk of PAD increases with established cardiovascular risk factors, such as, smoking, diabetes, hypertension, or hyperlipidemia. At the same time, there is a marked increase in cardiovascular morbidity and mortality associated with PAD. Thus, patients with PAD are at high risk for major adverse cardiovascular events (MACE) and at high risk for major adverse limb events (MALE).<a class="elsevierStyleCrossRef" href="#bib0300"><span class="elsevierStyleSup">3</span></a> Indeed, within 5 years of PAD diagnosis, 20% develop myocardial infarction or stroke, and the mortality is 10%–15%.<a class="elsevierStyleCrossRef" href="#bib0305"><span class="elsevierStyleSup">4</span></a> In the Framingham study, 75% of PAD patients died from cardiovascular events, and in patients with intermittent claudication, mortality was 2–3 times higher.<a class="elsevierStyleCrossRef" href="#bib0310"><span class="elsevierStyleSup">5</span></a> For these reasons, current European Society of Cardiology (ESC) Guidelines on cardiovascular disease prevention classify PAD patients as patients at very high cardiovascular risk.<a class="elsevierStyleCrossRef" href="#bib0315"><span class="elsevierStyleSup">6</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">The aim of this article is to review data on the epidemiology, risk factors, pathophysiology, diagnosis, and treatment of PAD, providing an up-to-date overview of this condition.</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0030">Epidemiology</span><p id="par0025" class="elsevierStylePara elsevierViewall">The global burden of PAD has increased by 25% compared to the past decade, mainly due to an increase in its prevalence in low- and middle-income countries. PAD affects now to more than 200 million people worldwide,<a class="elsevierStyleCrossRef" href="#bib0320"><span class="elsevierStyleSup">7</span></a> approximately between 12% and 14% of the general population, and its prevalence increases to nearly 30% in patients over 50 years of age. A systematic review estimated that the global prevalence of PAD in the population aged ≥25 years was ≈6% in 2015, thus approximately 236 million adults worldwide were living with PAD. The prevalence was higher in high-income countries than in low- and middle-income countries (7.37% vs. 5.09%, respectively); however, reflecting the population size, most individuals with PAD (72.9%) were in low- and middle-income countries.<a class="elsevierStyleCrossRef" href="#bib0325"><span class="elsevierStyleSup">8</span></a> Despite this, PAD is often underdiagnosed because it may also be present without ischaemic or typical symptoms consistent with intermittent claudication.</p><p id="par0030" class="elsevierStylePara elsevierViewall">Regarding sex, males have typically been found to be more affected than females.<a class="elsevierStyleCrossRef" href="#bib0330"><span class="elsevierStyleSup">9</span></a> However, this seems to be a characteristic of high-income countries, since females experience PAD up to two times the rate of males in lower-income countries.<a class="elsevierStyleCrossRef" href="#bib0335"><span class="elsevierStyleSup">10</span></a> Furthermore, the prevalence of PAD increases importantly with age in both males and females and in either high- or low-middle income countries.<a class="elsevierStyleCrossRef" href="#bib0325"><span class="elsevierStyleSup">8</span></a></p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Etiology and risk factors for peripheral artery disease</span><p id="par0035" class="elsevierStylePara elsevierViewall">Several risk factors increase the risk of PAD, most of which are well-known modifiable and non-modifiable cardiovascular risk factors (<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>). Thus, the major risk factors for development of PAD are smoking, diabetes mellitus, hyperlipidemia, hypertension, overweight/obesity, age, sex, and race/ethnicity.<a class="elsevierStyleCrossRefs" href="#bib0340"><span class="elsevierStyleSup">11,12</span></a></p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0040" class="elsevierStylePara elsevierViewall">Smoking is one of the strongest risk factors for PAD, and some studies have demonstrated that more than 80% of patients with PAD were smokers.<a class="elsevierStyleCrossRef" href="#bib0350"><span class="elsevierStyleSup">13</span></a> Current smokers have a 2.7-fold higher risk of PAD,<a class="elsevierStyleCrossRef" href="#bib0355"><span class="elsevierStyleSup">14</span></a> and PAD patients currently smoking have a double rate of cardiovascular mortality than those who have never smoked.<a class="elsevierStyleCrossRef" href="#bib0360"><span class="elsevierStyleSup">15</span></a> Experimental studies have demonstrated that these complications may be attributed to endothelial dysfunction and increased oxidative stress. Free radical-mediated oxidative stress plays a key role in smoking-mediated atherosclerotic and thrombotic diseases.<a class="elsevierStyleCrossRef" href="#bib0365"><span class="elsevierStyleSup">16</span></a></p><p id="par0045" class="elsevierStylePara elsevierViewall">Diabetes also acts as an important risk factor, increasing the risk of PAD by 1.7-fold.<a class="elsevierStyleCrossRef" href="#bib0320"><span class="elsevierStyleSup">7</span></a> PAD patients with diabetes suffer from a more aggressive and a more rapidly progressive form of PAD. Indeed, diabetes is associated with atherosclerosis progression and a higher risk of cardiovascular outcomes, leading to a higher risk of major amputation and mortality.<a class="elsevierStyleCrossRefs" href="#bib0370"><span class="elsevierStyleSup">17,18</span></a></p><p id="par0050" class="elsevierStylePara elsevierViewall">Hyperlipidemia, or a high cholesterol level, is another known risk factor for the development of PAD. Some studies have found that there is a 5% to 10% increment in the risk of developing PAD for every 10<span class="elsevierStyleHsp" style=""></span>mg increase in total cholesterol,<a class="elsevierStyleCrossRef" href="#bib0380"><span class="elsevierStyleSup">19</span></a> and hyperlipidemia leads to atherosclerosis, which has important implications in the pathophysiology of PAD.</p><p id="par0055" class="elsevierStylePara elsevierViewall">An increased systolic blood pressure (SBP) is an independent risk factor for PAD. Several studies estimated that hypertension provides an ≈40% raised risk of suffering from PAD.<a class="elsevierStyleCrossRef" href="#bib0340"><span class="elsevierStyleSup">11</span></a> In the ARIC study, SBP was associated with a high risk of PAD with a relative risk of approximately 2.6 when SBP was ≥140<span class="elsevierStyleHsp" style=""></span>mmHg and approximately 1.6 if it ranged from 120 to 139<span class="elsevierStyleHsp" style=""></span>mmHg.<a class="elsevierStyleCrossRef" href="#bib0385"><span class="elsevierStyleSup">20</span></a></p><p id="par0060" class="elsevierStylePara elsevierViewall">Other cardiac diseases, including coronary artery disease (CAD), are common in patients with PAD. For example, the coexistence of atrial fibrillation (AF), CAD and PAD is usual and related with a higher risk of worse clinical outcomes.<a class="elsevierStyleCrossRefs" href="#bib0390"><span class="elsevierStyleSup">21,22</span></a> In a recent study, 62.8% of patients had CAD as a factor associated with PAD, suggesting that PAD patients should be screened for CAD to prevent coronary constriction-related events in the future.<a class="elsevierStyleCrossRef" href="#bib0400"><span class="elsevierStyleSup">23</span></a></p><p id="par0065" class="elsevierStylePara elsevierViewall">Overweight, and particularly obesity, are important risk factor for PAD, and is strongly associated with an inflammatory state as seen by the presence of increased C-reactive protein (CRP) and fibrinogen levels, among other biomarkers for inflammation.<a class="elsevierStyleCrossRef" href="#bib0345"><span class="elsevierStyleSup">12</span></a> For example, the waist-to-hip ratio, a marker of abdominal obesity, is associated with PAD independent of other cardiovascular risk factors.<a class="elsevierStyleCrossRef" href="#bib0405"><span class="elsevierStyleSup">24</span></a></p><p id="par0070" class="elsevierStylePara elsevierViewall">As previously mentioned, the prevalence of PAD increases with age hence elderly individuals are more prone to suffer from PAD. According to the National Health and Nutrition Examination Survey, the prevalence of PAD in individuals aged ≥70 years was around 15%.<a class="elsevierStyleCrossRef" href="#bib0410"><span class="elsevierStyleSup">25</span></a></p><p id="par0075" class="elsevierStylePara elsevierViewall">Regarding sex, the overall prevalence of PAD in males and females has been estimated to be almost the same, although males have a higher chance of developing atherosclerotic diseases.<a class="elsevierStyleCrossRef" href="#bib0340"><span class="elsevierStyleSup">11</span></a> However, PAD seems to be more common among males in high-income countries, whereas females experience PAD up to two times the rate of men in lower-income countries.<a class="elsevierStyleCrossRef" href="#bib0325"><span class="elsevierStyleSup">8</span></a> Males are slightly more affected than females of CLTI, the most severe form of PAD (males: 3.11 per 1000 patients vs. females: 2.0 per 1000 patients).<a class="elsevierStyleCrossRef" href="#bib0415"><span class="elsevierStyleSup">26</span></a></p><p id="par0080" class="elsevierStylePara elsevierViewall">Finally, there are some differences in the risk of PAD in terms of race. Black individuals have more than twice the risk of developing PAD compared to non-black subjects. In addition, black patients presented with a more severe PAD status with an elevated risk of amputation, as well as cardiovascular morbidity and mortality.<a class="elsevierStyleCrossRefs" href="#bib0375"><span class="elsevierStyleSup">18,27</span></a></p><p id="par0085" class="elsevierStylePara elsevierViewall">Altogether, these comorbidities and characteristics enhance the risk of PAD in a cumulative manner, moving from a 1.5-fold increase in the presence of one single risk factor to 10.2-fold in the presence of three or more risk factors.<a class="elsevierStyleCrossRef" href="#bib0425"><span class="elsevierStyleSup">28</span></a></p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Pathophysiology</span><p id="par0090" class="elsevierStylePara elsevierViewall">It is well established that atherosclerosis is the cornerstone of the pathophysiology process in PAD, and different hypotheses have emerged for the development of atheroma plaques.<a class="elsevierStyleCrossRef" href="#bib0430"><span class="elsevierStyleSup">29</span></a> The pathogenesis is complex and involves several pathways, being the key processes the large accumulation of lipids and the intimal thickening in large and medium arteries. Different cell types contribute to the development of atheroma plaques, including vascular smooth muscle cells, endothelial cells, platelets, fibroblasts, and inflammatory cells, among others. Atherosclerosis disturbs homeostasis and promotes a prothrombotic response. Consequently, this prothrombotic state accelerates atherosclerosis, and even in the absence of an acute occlusive phenomenon, it produces ischaemic symptoms due to progressive stenosis of the vessel. Ultimately, atherosclerosis may lead to thrombosis by arterial occlusion if an atherosclerotic plaque is ruptured, which aggravates the process, increases vascular involvement, and leads to adverse clinical outcomes with limited prognosis (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>).</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0095" class="elsevierStylePara elsevierViewall">When vascular damage occurs, tissue factor (TF) is released by endothelial cells, resulting in the main initiator of blood clot formation. TF is naturally produced by smooth muscle cells in blood vessels, pericytes, and adventitial fibroblasts forming a haemostatic barrier. When the vessel wall is damaged, this barrier initiates the coagulation process. Factors IX and X are activated due to the association between TF and plasma factor VII. Extracellular TF signalling proceeds via the generation of different mediators of the coagulation cascade, including FVIIa, FXa, and FIIa. An essential cofactor for FXa is FVa, which forms the prothrombinase complex that converts prothrombin to thrombin, leading to fibrin formation.<a class="elsevierStyleCrossRef" href="#bib0435"><span class="elsevierStyleSup">30</span></a> In a model of carotid artery injury, mice expressing low levels of TF demonstrate reduced thrombosis, with the vessel wall being the main source of TF.<a class="elsevierStyleCrossRef" href="#bib0440"><span class="elsevierStyleSup">31</span></a> Atypical levels of TF have primarily been identified in early atherosclerotic lesions compared with advanced atherosclerotic plaques. This indicates a procoagulant state during the initial stages of atherosclerosis. Additionally, this is exacerbated by a decrease in coagulation inhibitor pathways, as evidenced by a higher TF pathway inhibitor ratio in patients with early stage atherosclerosis.<a class="elsevierStyleCrossRef" href="#bib0445"><span class="elsevierStyleSup">32</span></a></p><p id="par0100" class="elsevierStylePara elsevierViewall">Platelets react to endothelial injury by activating themselves and undergoing adhesion and aggregation, and release thromboxane-A2, serotonin, platelet factors, and coagulation factors. Thus, the coagulation cascade is initiated, and the deposition of fibrin exacerbates the vascular occlusion.<a class="elsevierStyleCrossRefs" href="#bib0445"><span class="elsevierStyleSup">32,33</span></a> Thrombin activates platelets, releasing FV and FVa along with FVIII from von Willebrand factor (vWF). These factors bind together to platelet surfaces and generate large amounts of thrombin, along with the prothrombinase complex, thus accelerating the transformation of fibrinogen to fibrin. The FVIIIa/FIXa and the prothrombinase complexes accelerate the production of Factor Xa and thrombin, respectively. In the surface of the platelets, Factor Xa associated with FVa causes the activation of prothrombin to thrombin, leading to the formation of fibrin from fibrinogen. Protofibrils of fibrin are stabilized by FXIIIa, leading to the formation of a network of fibrin and platelets aggregates, forming a thrombus.<a class="elsevierStyleCrossRef" href="#bib0450"><span class="elsevierStyleSup">33</span></a></p><p id="par0105" class="elsevierStylePara elsevierViewall">During the entire process, pro-inflammatory cytokines are activated, causing an elevated expression of low-density lipoprotein (LDL) receptors. This activation also contributes to the migration of fibroblasts, platelets, and smooth muscle cells to the intima, deposition of extracellular matrix components to form an atheromatous plaque, and the prevention of major complications. This atheromatous plaque may grow and cause occlusion of the artery, resulting in ischaemia in the tissues beyond the blockage.<a class="elsevierStyleCrossRef" href="#bib0455"><span class="elsevierStyleSup">34</span></a> Plaque rupture leads to thrombosis by obliterating the vascular lumen. The generated thrombus may even be fragmented, resulting in embolization of the distal circulation and worsening of symptoms.<a class="elsevierStyleCrossRef" href="#bib0450"><span class="elsevierStyleSup">33</span></a></p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Diagnosis</span><p id="par0110" class="elsevierStylePara elsevierViewall">The diagnosis of PAD is not always simple, mainly because only a limited proportion of patients present with classical symptoms or intermittent claudication. PAD can be asymptomatic, especially in its early stages, and when clinical manifestations appear, they are predominantly due to the progressive narrowing of the vascular lumen. In addition, among those with lower-limb symptoms, it is important to distinguish PAD from other causes of leg pain.<a class="elsevierStyleCrossRef" href="#bib0460"><span class="elsevierStyleSup">35</span></a></p><p id="par0115" class="elsevierStylePara elsevierViewall">To this end, a complete physical examination and clinical history, are recommended. Certainly, thorough physical examination is central. The lower limbs should be explored, and assess whether the feet are cold, whether there is good perfusion, as well as palpate the pedal, posterior tibial, popliteal, and femoral pulses.</p><p id="par0120" class="elsevierStylePara elsevierViewall">In addition, the clinical history should include an evaluation of different cardiovascular risk factors, such as lifestyle habits, diet, and physical activity. Some questionnaires with accurate results are available for the evaluation of functional status.<a class="elsevierStyleCrossRef" href="#bib0465"><span class="elsevierStyleSup">36</span></a> For example, the Edinburgh Claudication Questionnaire has a sensitivity of 91.3% (95% CI 88.1%–94.5%) and a specificity of 99.3% (95% CI 98.9%–100%),<a class="elsevierStyleCrossRef" href="#bib0470"><span class="elsevierStyleSup">37</span></a> which may assist in the diagnostic process (<a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>).</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><p id="par0125" class="elsevierStylePara elsevierViewall">However, specific tests are needed for the proper diagnosis of PAD, being the ankle-brachial index (ABI) the most widely used and recommended by international guidelines.<a class="elsevierStyleCrossRefs" href="#bib0460"><span class="elsevierStyleSup">35,36</span></a> ABI is an inexpensive, non-invasive, and minimally time-consuming method, consisting of measuring the systolic blood pressure on the brachial artery (arm) and the dorsal pedis or posterior tibial artery (ankle) while the patient is supine position, using a continuous-wave Doppler device (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>). The results are obtained by dividing the highest systolic blood pressure at the ankle by the highest systolic blood pressure at the arm.<a class="elsevierStyleCrossRef" href="#bib0475"><span class="elsevierStyleSup">38</span></a> An ABI <0.9 suggests PAD and is associated with more than doubling of the 10-year rates of coronary events, cardiovascular mortality, and total mortality. An ABI >1.40 represents arterial calcification and is also associated with a higher cardiovascular risk.<a class="elsevierStyleCrossRef" href="#bib0310"><span class="elsevierStyleSup">5</span></a> As limitations, this method requires good training from the operator before obtaining reliable results, and it might be insufficient for the detection of PAD in patients with diabetes and/or chronic kidney disease because of the higher probability of medial calcification.</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0130" class="elsevierStylePara elsevierViewall">Another different technique used for the screening and diagnosis of PAD is Duplex ultrasound (DUS).<a class="elsevierStyleCrossRef" href="#bib0480"><span class="elsevierStyleSup">39</span></a> It is most commonly used for follow-up after a revascularization process and for evaluating of the severity and extent of PAD because of its capacity to determine the direction and velocity of blood flow through an artery.<a class="elsevierStyleCrossRef" href="#bib0485"><span class="elsevierStyleSup">40</span></a> The information provided using DUS can be used for better treatment selection, and DUS can detect subclinical artery disease (e.g. carotid plaque).</p><p id="par0135" class="elsevierStylePara elsevierViewall">Angiography is used for peripheral artery imaging, either using iodine contrast in the case of multidetector computed tomography angiography (CTA) or not using iodinated contrast as in magnetic resonance angiography (MRA). CTA offers rapid, non-invasive acquisition, wide availability, high resolution, and 3D reformatting, but the major limitation is the need for intravenous iodinated contrast agents and high radiation exposure. In contrast, MRA does not require iodinated contrast and has higher soft tissue resolution, however it has certain limitations because motion artefacts are more frequent and contraindications include pacemakers and implantable cardioverter defibrillators.<a class="elsevierStyleCrossRefs" href="#bib0465"><span class="elsevierStyleSup">36,39</span></a></p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Treatment</span><p id="par0140" class="elsevierStylePara elsevierViewall">The treatment of PAD should be based on cardiovascular risk factor management, including non-pharmacological and optimal pharmacological therapies as well as surgical interventions when needed. The goal is to reduce lower extremities pain, to protect against amputation, and to prevent different adverse cardiovascular outcomes associated to PAD.<a class="elsevierStyleCrossRefs" href="#bib0460"><span class="elsevierStyleSup">35,36</span></a></p><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0055">Lifestyle management</span><p id="par0145" class="elsevierStylePara elsevierViewall">The first approach to the treatment of PAD would be lifestyle management, with measures such as smoking cessation, healthy diet, weight loss, and regular physical exercise. It is central to enhance smoking cessation through behavioural therapy and intensive counselling. Pharmacological therapies should also be considered, from nicotine replacement therapy such as gum and patches to bupropion and varenicline.<a class="elsevierStyleCrossRef" href="#bib0460"><span class="elsevierStyleSup">35</span></a> A meta-analysis of randomized trials involving PAD patients where different smoking interventions were evaluated, suggested such smoking cessation interventions increased the chance of quitting smoking (RR 1.48, 95% CI 0.84–2.61).<a class="elsevierStyleCrossRef" href="#bib0490"><span class="elsevierStyleSup">41</span></a> In summary, general advice is to quit smoking because it is a major risk factor for PAD and smoking reduction decreases the risk of MACE and MALE.</p><p id="par0150" class="elsevierStylePara elsevierViewall">Current guidelines on the management of PAD recommend a healthy diet and physical activity because of their benefits in PAD patients.<a class="elsevierStyleCrossRef" href="#bib0465"><span class="elsevierStyleSup">36</span></a> A review revealed that exercise programmes significantly improved the pain-free walking distance as well as the maximum distance walked by people with leg pain, but no evidence was found regarding the effect of exercise on death or amputation.<a class="elsevierStyleCrossRef" href="#bib0495"><span class="elsevierStyleSup">42</span></a> In patients with intermittent claudication, supervised exercise training is recommended (Class of recommendation I, Level of evidence A), but even non-supervised exercise training is appropriate when supervised exercise training is not feasible or available (Class of recommendation I, Level of evidence C).<a class="elsevierStyleCrossRef" href="#bib0315"><span class="elsevierStyleSup">6</span></a></p></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0060">Lipid-lowering drugs</span><p id="par0155" class="elsevierStylePara elsevierViewall">Another important approach is reducing the serum low-density lipoprotein cholesterol level to <55<span class="elsevierStyleHsp" style=""></span>mg/dl in high cardiovascular risk patients according to the 2019 ESC Guidelines for the management of dyslipidaemias, and even lower (<40<span class="elsevierStyleHsp" style=""></span>mg/dl) for higher-risk patients with multiple recent cardiovascular outcomes.<a class="elsevierStyleCrossRef" href="#bib0500"><span class="elsevierStyleSup">43</span></a> There is strong evidence that the use of statins reduces cholesterol levels in PAD patients and even decreases all-cause mortality and cardiovascular events.<a class="elsevierStyleCrossRef" href="#bib0505"><span class="elsevierStyleSup">44</span></a> It has been demonstrated that statin use is associated with a 17% decrease in different cardiovascular outcomes in PAD patients (from asymptomatic to severe cases).<a class="elsevierStyleCrossRef" href="#bib0510"><span class="elsevierStyleSup">45</span></a> For these reasons, aggressive lipid-lowering with statins is recommended by guidelines,<a class="elsevierStyleCrossRefs" href="#bib0460"><span class="elsevierStyleSup">35,36</span></a> and a combination of statins with ezetimibe or proprotein convertase subtilisin/kexin type 9 (PCSK9) inhibitors could also be beneficial.</p></span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0065">Antihypertensive drugs</span><p id="par0160" class="elsevierStylePara elsevierViewall">Blood pressure control is an important pillar of the management of PAD patients. The current recommended target is blood pressure (BP) <140/90<span class="elsevierStyleHsp" style=""></span>mmHg. However, the most recent guidelines for the management of arterial hypertension introduced stricter control of BP (<130/80<span class="elsevierStyleHsp" style=""></span>mmHg) for adults with increased cardiovascular risk, such as PAD patients, while paying attention to a possible worsening of symptoms in some patients, in whom 140/80<span class="elsevierStyleHsp" style=""></span>mmHg would be reinstated as a reference value.<a class="elsevierStyleCrossRefs" href="#bib0515"><span class="elsevierStyleSup">46–48</span></a> To achieve this goal, lifestyle modifications including diet (particularly salt intake <5–6<span class="elsevierStyleHsp" style=""></span>g/day), exercise, weight management, alcohol reduction, stress management, and self-monitoring of blood pressure are highly encouraged. For patients requiring pharmacological approaches, diuretics, beta-blockers, calcium antagonists, angiotensin-converting enzyme inhibitors (ACEIs), and angiotensin receptor blockers (ARBs) are all suitable antihypertensive treatments, although ACE inhibitors or ARBs should be considered as first-line therapy in patients with PAD and hypertension.<a class="elsevierStyleCrossRefs" href="#bib0460"><span class="elsevierStyleSup">35,36</span></a></p></span><span id="sec0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Antidiabetic agents</span><p id="par0165" class="elsevierStylePara elsevierViewall">In patients with diabetes, optimal glucose level control needs to be achieved, which improves limb outcomes.<a class="elsevierStyleCrossRef" href="#bib0530"><span class="elsevierStyleSup">49</span></a> The choice of antidiabetics for PAD patients should be individualized based on the patient's wishes, preferences, and financial support/drug coverage. Patients with PAD and diabetes may benefit from the use of glucagon-like peptide 1 agonists or dipeptidyl peptidase 4 inhibitors. However, the emergence of sodium-glucose cotransporter 2 (SGLT-2) inhibitors has promoted a paradigm shift. Hence, this family of drugs is now recommended because of the reduction in mortality, MACE, and MALE.<a class="elsevierStyleCrossRef" href="#bib0460"><span class="elsevierStyleSup">35</span></a></p></span><span id="sec0055" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Antithrombotics</span><p id="par0170" class="elsevierStylePara elsevierViewall">Antithrombotic therapy has been based on the use of antiplatelets due to the suppression of platelet hyperactivity, reducing the process leading to thrombus formation and preventing cardiovascular and limb-related outcomes in patients with PAD.<a class="elsevierStyleCrossRef" href="#bib0535"><span class="elsevierStyleSup">50</span></a> These drugs prevent limb-related and cardiovascular events in patients with lower-extremity PAD; therefore, long-term antiplatelet therapy is recommended for symptomatic patients according to international clinical practice guidelines.<a class="elsevierStyleCrossRefs" href="#bib0460"><span class="elsevierStyleSup">35,36,51</span></a> Although the optimal antiplatelet strategy remains unclear, single antiplatelet therapy (SAPT) with either acetylsalicylic acid (ASA) or clopidogrel (75<span class="elsevierStyleHsp" style=""></span>mg) could be considered.</p><p id="par0175" class="elsevierStylePara elsevierViewall">However, the current ESC guidelines suggest the use of clopidogrel over ASA (Class of recommendation IIb; level of evidence B).<a class="elsevierStyleCrossRef" href="#bib0465"><span class="elsevierStyleSup">36</span></a> So far, dual antiplatelet therapy (DAPT) is only recommended in lower-extremity PAD patients with recent acute coronary syndrome and/or percutaneous coronary intervention (<1 year), or after lower-extremity revascularization. In these patients, DAPT with ASA and a P2Y12 inhibitor may be considered for a short period of time.<a class="elsevierStyleCrossRefs" href="#bib0460"><span class="elsevierStyleSup">35,36,51</span></a></p><p id="par0180" class="elsevierStylePara elsevierViewall">The role of oral anticoagulation (OAC) remains controversial. Thus, current guidelines recommend OAC therapy only if there is a concomitant indication and it may be combined with SPAT in the context of recent revascularization.<a class="elsevierStyleCrossRef" href="#bib0465"><span class="elsevierStyleSup">36</span></a> Nevertheless, the ‘Rivaroxaban for the Prevention of Major Cardiovascular Events in Coronary or Peripheral Artery Disease (COMPASS)’<a class="elsevierStyleCrossRef" href="#bib0545"><span class="elsevierStyleSup">52</span></a> and the ‘Vascular Outcomes Study of ASA Along With Rivaroxaban in Endovascular or Surgical Limb Revascularization for Peripheral Artery Disease (VOYAGER PAD)’,<a class="elsevierStyleCrossRef" href="#bib0550"><span class="elsevierStyleSup">53</span></a> have completely changed the landscape. In a sub-analysis of the COMPASS trial focusing specifically on patients with lower-extremity PAD, MALE events were significantly associated with a higher risk of subsequent hospitalization, amputation, and death. The combination of rivaroxaban 2.5<span class="elsevierStyleHsp" style=""></span>mg twice daily and ASA reduced the incidence of MALE by 43%, total vascular amputations by 58%, peripheral vascular interventions by 24%, and all peripheral vascular outcomes by 24%, compared with ASA alone.<a class="elsevierStyleCrossRef" href="#bib0555"><span class="elsevierStyleSup">54</span></a> Similarly, in the VOYAGER PAD trial, there was a significant reduction in the composite of acute limb ischaemia, major amputation for vascular causes, myocardial infarction, ischaemic stroke, or death from cardiovascular causes, in patients in the rivaroxaban arm at 3-years of follow-up. In terms of safety, major bleeding was significantly higher in the rivaroxaban group according to the ISTH major bleeding definition but not according to the TIMI major bleeding definition.<a class="elsevierStyleCrossRef" href="#bib0560"><span class="elsevierStyleSup">55</span></a> Given these results, the current 2022 Canadian Cardiovascular Society 2022 Guidelines already recommend treatment with rivaroxaban 2.5<span class="elsevierStyleHsp" style=""></span>mg twice daily in combination with ASA (80–100<span class="elsevierStyleHsp" style=""></span>mg daily) in patients with symptomatic lower-extremity PAD who are at high risk for ischaemic events (high-risk comorbidities such as polyvascular disease, diabetes, history of heart failure, or renal insufficiency) and low bleeding risk.<a class="elsevierStyleCrossRef" href="#bib0460"><span class="elsevierStyleSup">35</span></a></p></span><span id="sec0060" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Surgery</span><p id="par0185" class="elsevierStylePara elsevierViewall">Surgical intervention to reperfuse the limb due to ischaemia may be considered in patients whose previous strategies have failed to alleviate intermittent claudication and whose leg pain is so severe that it prevents them from performing exercise strategies on a regular basis. This can be achieved in different ways. The first is endarterectomy, i.e. removing the plaque narrowing the artery, applied for focal lesions in large vessels, with an important limitation in securing the endpoints and intimal hyperplasia, resulting in stenosis. Other options include an artery bypass graft, which involves bypassing the blockage on the artery using prosthetic grafts in the case of large-calibre arteries, with the limitation of a potential infection and even a thrombotic event; or endovascular techniques such as angioplasty, used to widen narrowed arteries using a balloon-tipped catheter through the stenosed arterial site, often conducted for patients with intermittent claudication.<a class="elsevierStyleCrossRef" href="#bib0565"><span class="elsevierStyleSup">56</span></a></p><p id="par0190" class="elsevierStylePara elsevierViewall">The only trial comparing the effectiveness of bypass surgery with angioplasty in CLTI patients was the BASIL trial, where randomized patients were followed-up for ≥5 years after a surgery-first or angioplasty-first approach. After 2 years, patients who underwent bypass surgery showed higher survival, with a trend towards improved amputation-free survival.<a class="elsevierStyleCrossRef" href="#bib0570"><span class="elsevierStyleSup">57</span></a> Currently, the best option for every patient is based on previous conditions, clinical presentation, treatment duration, and anatomic pattern of obstructive arterial disease.<a class="elsevierStyleCrossRef" href="#bib0465"><span class="elsevierStyleSup">36</span></a></p></span></span><span id="sec0065" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Conclusions</span><p id="par0195" class="elsevierStylePara elsevierViewall">PAD is a common condition related to atherosclerotic vascular disease, which remains underdiagnosed and undertreated. The most common manifestation of PAD is intermittent claudication, associated with reduced mobility and leg pain. Nevertheless, asymptomatic PAD is the most common type of PAD worldwide. Different studies have suggested the relevance of atherothrombosis in the development of PAD, including the systemic risks associated with atherothrombosis, such as myocardial infarction, stroke, and death. However, the negative impact of PAD on health is commonly underestimated by patients and healthcare providers despite it confers a risk of adverse events similar to CAD or cerebrovascular disease.</p><p id="par0200" class="elsevierStylePara elsevierViewall">The management of PAD is multifactorial and should start with lifestyle modifications, with measures such as smoking cessation, healthy diet, weight loss, and regular physical exercise. An optimal pharmacological approach, including lipid-lowering drugs, antihypertensive drugs, antidiabetic agents, and antithrombotics, is also required. New advancements in the diagnosis and management strategies of PAD are needed to overcome the different adverse outcomes and improve the overall quality of life of patients.</p></span><span id="sec0070" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Ethical considerations</span><p id="par0205" class="elsevierStylePara elsevierViewall">Written informed consent was not obtained nor required for this study.</p></span><span id="sec0075" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">Funding</span><p id="par0210" class="elsevierStylePara elsevierViewall">None.</p></span><span id="sec0080" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0100">Conflicts of interest</span><p id="par0215" class="elsevierStylePara elsevierViewall">None.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:15 [ 0 => array:3 [ "identificador" => "xres1993202" "titulo" => "Abstract" "secciones" => array:1 [ 0 => array:1 [ "identificador" => "abst0005" ] ] ] 1 => array:2 [ "identificador" => "xpalclavsec1710262" "titulo" => "Keywords" ] 2 => array:3 [ "identificador" => "xres1993201" "titulo" => "Resumen" "secciones" => array:1 [ 0 => array:1 [ "identificador" => "abst0010" ] ] ] 3 => array:2 [ "identificador" => "xpalclavsec1710263" "titulo" => "Palabras clave" ] 4 => array:2 [ "identificador" => "sec0005" "titulo" => "Introduction" ] 5 => array:2 [ "identificador" => "sec0010" "titulo" => "Epidemiology" ] 6 => array:2 [ "identificador" => "sec0015" "titulo" => "Etiology and risk factors for peripheral artery disease" ] 7 => array:2 [ "identificador" => "sec0020" "titulo" => "Pathophysiology" ] 8 => array:2 [ "identificador" => "sec0025" "titulo" => "Diagnosis" ] 9 => array:3 [ "identificador" => "sec0030" "titulo" => "Treatment" "secciones" => array:6 [ 0 => array:2 [ "identificador" => "sec0035" "titulo" => "Lifestyle management" ] 1 => array:2 [ "identificador" => "sec0040" "titulo" => "Lipid-lowering drugs" ] 2 => array:2 [ "identificador" => "sec0045" "titulo" => "Antihypertensive drugs" ] 3 => array:2 [ "identificador" => "sec0050" "titulo" => "Antidiabetic agents" ] 4 => array:2 [ "identificador" => "sec0055" "titulo" => "Antithrombotics" ] 5 => array:2 [ "identificador" => "sec0060" "titulo" => "Surgery" ] ] ] 10 => array:2 [ "identificador" => "sec0065" "titulo" => "Conclusions" ] 11 => array:2 [ "identificador" => "sec0070" "titulo" => "Ethical considerations" ] 12 => array:2 [ "identificador" => "sec0075" "titulo" => "Funding" ] 13 => array:2 [ "identificador" => "sec0080" "titulo" => "Conflicts of interest" ] 14 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2023-05-11" "fechaAceptado" => "2023-06-21" "PalabrasClave" => array:2 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec1710262" "palabras" => array:5 [ 0 => "Peripheral artery disease" 1 => "Epidemiology" 2 => "Risk factors" 3 => "Diagnosis" 4 => "Treatment" ] ] ] "es" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec1710263" "palabras" => array:5 [ 0 => "Enfermedad arterial periférica" 1 => "Epidemiología" 2 => "Factores de riesgo" 3 => "Diagnóstico" 4 => "Tratamiento" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "en" => array:2 [ "titulo" => "Abstract" "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Peripheral artery disease (PAD) is a condition related to atherosclerosis affecting >200 million people worldwide, and it increases cardiovascular morbidity (mainly from myocardial infarction and stroke) and mortality. Indeed, PAD patients are classified as patients at very high cardiovascular risk. The most common manifestation of PAD is intermittent claudication, which is associated with reduced mobility and leg pain. Nevertheless, asymptomatic PAD is the most frequent form of PAD worldwide; therefore, it remains underdiagnosed and undertreated. The major risk factors for PAD are smoking, diabetes mellitus, hyperlipidemia, hypertension, overweight/obesity, age, male sex, and black race. Hence, the first and most relevant approach in PAD treatment is lifestyle management, with measures such as smoking cessation, healthy diet, weight loss, and regular physical exercise. This should also be supported by an optimal pharmacological approach including lipid-lowering drugs, antihypertensive drugs, antidiabetic agents, and antithrombotics.</p></span>" ] "es" => array:2 [ "titulo" => "Resumen" "resumen" => "<span id="abst0010" class="elsevierStyleSection elsevierViewall"><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">La enfermedad arterial periférica (EAP) es una afección relacionada con la aterosclerosis que afecta a más de 200 millones de personas en todo el mundo y aumenta la morbilidad cardiovascular (principalmente por infarto de miocardio e ictus) y la mortalidad. De hecho, los pacientes con EAP se clasifican como pacientes de muy alto riesgo cardiovascular. La manifestación más común de la EAP es la claudicación intermitente, que se asocia con movilidad reducida y dolor en las piernas. No obstante, la EAP asintomática es la forma más frecuente de EAP en todo el mundo, razón por la cual esta continúa estando infradiagnosticada e infratratada. Los principales factores de riesgo de la EAP son el tabaquismo, la diabetes mellitus, la hiperlipidemia, la hipertensión, el sobrepeso/obesidad, la edad, el sexo masculino y la raza negra. Por lo tanto, el primer enfoque y el más relevante en el tratamiento de la EAP es el manejo del estilo de vida, con medidas como el abandono del hábito tabáquico, una dieta saludable, la pérdida de peso y el ejercicio físico regular. Esto también debe estar respaldado por un enfoque farmacológico óptimo que incluya medicamentos hipolipemiantes, medicamentos antihipertensivos, agentes antidiabéticos y antitrombóticos.</p></span>" ] ] "multimedia" => array:4 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1307 "Ancho" => 3341 "Tamanyo" => 412039 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Thrombus formation and atherosclerotic plaque rupture in peripheral artery disease.</p>" ] ] 1 => array:7 [ "identificador" => "fig0010" "etiqueta" => "Fig. 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 1641 "Ancho" => 2925 "Tamanyo" => 324922 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">How to measure the ankle-brachial index?</p>" ] ] 2 => array:8 [ "identificador" => "tbl0005" "etiqueta" => "Table 1" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at1" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:1 [ "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Modifiable \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Non-modifiable \t\t\t\t\t\t\n \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleItalic">Related to lifestyle</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Age \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Smoking habit \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Sex (male) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Overweight/Obesity \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Race (Black) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleItalic">Comorbidities</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Diabetes \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Hyperlipidemia \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Coronary heart disease \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Hypertension \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab3311861.png" ] ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Principal risk factors for peripheral artery disease.</p>" ] ] 3 => array:8 [ "identificador" => "tbl0010" "etiqueta" => "Table 2" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at2" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:2 [ "leyenda" => "<p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">A positive classification for peripheral artery disease requires the indicated responses for all questions.</p>" "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Question \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Response \t\t\t\t\t\t\n \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1 - Do you get pain or discomfort in your leg(s) when you walk? \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Yes (if patient answers no, then stop here) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2 - Does this pain ever begin when you are standing still or sitting? \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">No \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">3 - Do you get pain if you walk uphill or hurry? \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Yes \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">4 - Do you get pain if you walk at an ordinary pace on level ground? \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Yes \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">5 - Does it disappear within 10<span class="elsevierStyleHsp" style=""></span>min when you stand still? \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Yes \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">6 - Do you feel the pain in your calves, thighs, or buttocks? \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Yes \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab3311860.png" ] ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">The Edinburgh claudication questionnaire.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0015" "bibliografiaReferencia" => array:57 [ 0 => array:3 [ "identificador" => "bib0290" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Peripheral arterial disease" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "J.V. Mascarenhas" 1 => "M.A. Albayati" 2 => "C.P. Shearman" 3 => "E.B. Jude" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.ecl.2013.09.003" "Revista" => array:6 [ "tituloSerie" => "Endocrinol Metab Clin North Am" "fecha" => "2014" "volumen" => "43" "paginaInicial" => "149" "paginaFinal" => "166" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/24582096" "web" => "Medline" ] ] ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0295" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "The role of circulating biomarkers in peripheral arterial disease" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "G. Saenz-Pipaon" 1 => "E. Martinez-Aguilar" 2 => "J. Orbe" 3 => "A. González Miqueo" 4 => "L. Fernandez-Alonso" 5 => "J.A. Paramo" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.3390/ijms22073601" "Revista" => array:5 [ "tituloSerie" => "Int J Mol Sci" "fecha" => "2021" "volumen" => "22" "paginaInicial" => "3601" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/33808453" "web" => "Medline" ] ] ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib0300" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "High mortality risks after major lower extremity amputation in Medicare patients with peripheral artery disease" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "W.S. Jones" 1 => "M.R. Patel" 2 => "D. Dai" 3 => "S. Vemulapalli" 4 => "S. Subherwal" 5 => "J. Stafford" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.ahj.2012.12.002" "Revista" => array:6 [ "tituloSerie" => "Am Heart J" "fecha" => "2013" "volumen" => "165" "paginaInicial" => "809" "paginaFinal" => "815" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23622919" "web" => "Medline" ] ] ] ] ] ] ] ] 3 => array:3 [ "identificador" => "bib0305" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Society for vascular surgery practice guidelines for atherosclerotic occlusive disease of the lower extremities: management of asymptomatic disease and claudication" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "M.S. Conte" 1 => "F.B. Pomposelli" 2 => "D.G. Clair" 3 => "P.J. Geraghty" 4 => "J.F. McKinsey" 5 => "J.L. Mills" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "J Vasc Surg" "fecha" => "2015" "volumen" => "61" "paginaInicial" => "2S" "paginaFinal" => "41S.e1" ] ] ] ] ] ] 4 => array:3 [ "identificador" => "bib0310" "etiqueta" => "5" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Ankle brachial index combined with Framingham Risk Score to predict cardiovascular events and mortality: a meta-analysis" "autores" => array:1 [ 0 => array:2 [ "colaboracion" => "ABI Collaboration" "etal" => false ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1001/jama.300.2.197" "Revista" => array:5 [ "tituloSerie" => "JAMA" "fecha" => "2008" "volumen" => "300" "paginaInicial" => "197" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/18612117" "web" => "Medline" ] ] ] ] ] ] ] ] 5 => array:3 [ "identificador" => "bib0315" "etiqueta" => "6" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "2021 ESC Guidelines on cardiovascular disease prevention in clinical practice" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "F.L.J. Visseren" 1 => "F. Mach" 2 => "Y.M. Smulders" 3 => "D. Carballo" 4 => "K.C. Koskinas" 5 => "M. Bäck" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1093/eurheartj/ehab484" "Revista" => array:6 [ "tituloSerie" => "Eur Heart J" "fecha" => "2021" "volumen" => "42" "paginaInicial" => "3227" "paginaFinal" => "3337" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/34458905" "web" => "Medline" ] ] ] ] ] ] ] ] 6 => array:3 [ "identificador" => "bib0320" "etiqueta" => "7" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Comparison of global estimates of prevalence and risk factors for peripheral artery disease in 2000 and 2010: a systematic review and analysis" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "F.G.R. Fowkes" 1 => "D. Rudan" 2 => "I. Rudan" 3 => "V. Aboyans" 4 => "J.O. Denenberg" 5 => "M.M. McDermott" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Lancet" "fecha" => "2013" "volumen" => "382" "paginaInicial" => "1329" "paginaFinal" => "1340" ] ] ] ] ] ] 7 => array:3 [ "identificador" => "bib0325" "etiqueta" => "8" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Global, regional, and national prevalence and risk factors for peripheral artery disease in 2015: an updated systematic review and analysis" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "P. Song" 1 => "D. Rudan" 2 => "Y. Zhu" 3 => "F.J. Fowkes" 4 => "K. Rahimi" 5 => "F.G.R. Fowkes" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/S2214-109X(19)30255-4" "Revista" => array:6 [ "tituloSerie" => "Lancet Glob Health" "fecha" => "2019" "volumen" => "7" "paginaInicial" => "e1020" "paginaFinal" => "e1030" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/31303293" "web" => "Medline" ] ] ] ] ] ] ] ] 8 => array:3 [ "identificador" => "bib0330" "etiqueta" => "9" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Sex related differences in therapy and outcome of patients with intermittent claudication in a real-world cohort" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "L. Makowski" 1 => "J. Feld" 2 => "J. Köppe" 3 => "J. Illner" 4 => "L. Kühnemund" 5 => "A. Wiederhold" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.atherosclerosis.2021.03.019" "Revista" => array:6 [ "tituloSerie" => "Atherosclerosis" "fecha" => "2021" "volumen" => "325" "paginaInicial" => "75" "paginaFinal" => "82" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/33901740" "web" => "Medline" ] ] ] ] ] ] ] ] 9 => array:3 [ "identificador" => "bib0335" "etiqueta" => "10" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Peripheral artery disease: epidemiology and global perspectives" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "F.G.R. Fowkes" 1 => "V. Aboyans" 2 => "F.J. Fowkes" 3 => "M.M. McDermott" 4 => "U.K. Sampson" 5 => "M.H. Criqui" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1038/nrcardio.2016.179" "Revista" => array:6 [ "tituloSerie" => "Nat Rev Cardiol" "fecha" => "2017" "volumen" => "14" "paginaInicial" => "156" "paginaFinal" => "170" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/27853158" "web" => "Medline" ] ] ] ] ] ] ] ] 10 => array:3 [ "identificador" => "bib0340" "etiqueta" => "11" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Epidemiology of peripheral artery disease and polyvascular disease" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "A.W. Aday" 1 => "K. Matsushita" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1161/CIRCRESAHA.121.318535" "Revista" => array:6 [ "tituloSerie" => "Circ Res" "fecha" => "2021" "volumen" => "128" "paginaInicial" => "1818" "paginaFinal" => "1832" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/34110907" "web" => "Medline" ] ] ] ] ] ] ] ] 11 => array:3 [ "identificador" => "bib0345" "etiqueta" => "12" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Epidemiology, classification, and modifiable risk factors of peripheral arterial disease" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "N.W. Shammas" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.2147/vhrm.2007.3.2.229" "Revista" => array:7 [ "tituloSerie" => "Vasc Health Risk Manag" "fecha" => "2007" "volumen" => "3" "paginaInicial" => "229" "paginaFinal" => "234" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/17580733" "web" => "Medline" ] ] "itemHostRev" => array:3 [ "pii" => "S1535610820305985" "estado" => "S300" "issn" => "15356108" ] ] ] ] ] ] ] 12 => array:3 [ "identificador" => "bib0350" "etiqueta" => "13" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Peripheral arterial disease in the elderly: the Rotterdam study" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "W.T. Meijer" 1 => "A.W. Hoes" 2 => "D. Rutgers" 3 => "M.L. Bots" 4 => "A. Hofman" 5 => "D.E. Grobbee" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1161/01.atv.18.2.185" "Revista" => array:6 [ "tituloSerie" => "Arterioscler Thromb Vasc Biol" "fecha" => "1998" "volumen" => "18" "paginaInicial" => "185" "paginaFinal" => "192" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/9484982" "web" => "Medline" ] ] ] ] ] ] ] ] 13 => array:3 [ "identificador" => "bib0355" "etiqueta" => "14" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Meta-analysis of the association between cigarette smoking and peripheral arterial disease" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "L. Lu" 1 => "D. Mackay" 2 => "J. Pell" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1136/heartjnl-2013-304082" "Revista" => array:6 [ "tituloSerie" => "Heart" "fecha" => "2014" "volumen" => "100" "paginaInicial" => "414" "paginaFinal" => "423" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23922053" "web" => "Medline" ] ] ] ] ] ] ] ] 14 => array:3 [ "identificador" => "bib0360" "etiqueta" => "15" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Risk factors for mortality among individuals with peripheral arterial disease" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "S.M. Amrock" 1 => "C.Z. Abraham" 2 => "E. Jung" 3 => "P.B. Morris" 4 => "M.D. Shapiro" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.amjcard.2017.05.057" "Revista" => array:6 [ "tituloSerie" => "Am J Cardiol" "fecha" => "2017" "volumen" => "120" "paginaInicial" => "862" "paginaFinal" => "867" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/28734461" "web" => "Medline" ] ] ] ] ] ] ] ] 15 => array:3 [ "identificador" => "bib0365" "etiqueta" => "16" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "The pathophysiology of cigarette smoking and cardiovascular disease: an update" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "J.A. Ambrose" 1 => "R.S. Barua" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "J Am Coll Cardiol" "fecha" => "2004" "volumen" => "43" "paginaInicial" => "1731" "paginaFinal" => "1737" ] ] ] ] ] ] 16 => array:3 [ "identificador" => "bib0370" "etiqueta" => "17" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Peripheral arterial disease, diabetes, and mortality" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "C.L. Leibson" 1 => "J.E. Ransom" 2 => "W. Olson" 3 => "B.R. Zimmerman" 4 => "W.M. O’Fallon" 5 => "P.J. Palumbo" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Diabetes Care" "fecha" => "2004" "volumen" => "27" "paginaInicial" => "2843" "paginaFinal" => "2849" ] ] ] ] ] ] 17 => array:3 [ "identificador" => "bib0375" "etiqueta" => "18" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Epidemiology and risk of amputation in patients with diabetes mellitus and peripheral artery disease" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "J.A. Barnes" 1 => "M.A. Eid" 2 => "M.A. Creager" 3 => "P.P. Goodney" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1161/ATVBAHA.120.314595" "Revista" => array:6 [ "tituloSerie" => "Arterioscler Thromb Vasc Biol" "fecha" => "2020" "volumen" => "40" "paginaInicial" => "1808" "paginaFinal" => "1817" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/32580632" "web" => "Medline" ] ] ] ] ] ] ] ] 18 => array:3 [ "identificador" => "bib0380" "etiqueta" => "19" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Ankle-arm index as a marker of atherosclerosis in the Cardiovascular Health Study. Cardiovascular Heart Study (CHS) Collaborative Research Group" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "A.B. Newman" 1 => "D.S. Siscovick" 2 => "T.A. Manolio" 3 => "J. Polak" 4 => "L.P. Fried" 5 => "N.O. Borhani" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1161/01.cir.88.3.837" "Revista" => array:6 [ "tituloSerie" => "Circulation" "fecha" => "1993" "volumen" => "88" "paginaInicial" => "837" "paginaFinal" => "845" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/8353913" "web" => "Medline" ] ] ] ] ] ] ] ] 19 => array:3 [ "identificador" => "bib0385" "etiqueta" => "20" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "2017 ACC/AHA blood pressure classification and incident peripheral artery disease: the Atherosclerosis Risk in Communities (ARIC) study" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "Y. Lu" 1 => "S.H. Ballew" 2 => "H. Tanaka" 3 => "M. Szklo" 4 => "G. Heiss" 5 => "J. Coresh" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1177/2047487319865378" "Revista" => array:6 [ "tituloSerie" => "Eur J Prev Cardiol" "fecha" => "2020" "volumen" => "27" "paginaInicial" => "51" "paginaFinal" => "59" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/31362534" "web" => "Medline" ] ] ] ] ] ] ] ] 20 => array:3 [ "identificador" => "bib0390" "etiqueta" => "21" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Relationship of peripheral and coronary artery disease to cardiovascular events in patients with atrial fibrillation" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "D. Pastori" 1 => "P. Pignatelli" 2 => "A. Sciacqua" 3 => "M. Perticone" 4 => "F. Violi" 5 => "G.Y. Lip" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.ijcard.2017.12.076" "Revista" => array:6 [ "tituloSerie" => "Int J Cardiol" "fecha" => "2018" "volumen" => "255" "paginaInicial" => "69" "paginaFinal" => "73" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/29290420" "web" => "Medline" ] ] ] ] ] ] ] ] 21 => array:3 [ "identificador" => "bib0395" "etiqueta" => "22" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Prognosis of atrial fibrillation in patients with symptomatic peripheral arterial disease: data from the REduction of Atherothrombosis for Continued Health (REACH) Registry" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "T. Winkel" 1 => "S. Hoeks" 2 => "O. Schouten" 3 => "U. Zeymer" 4 => "T. Limbourg" 5 => "I. Baumgartner" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.ejvs.2010.03.003" "Revista" => array:6 [ "tituloSerie" => "Eur J Vasc Endovasc Surg" "fecha" => "2010" "volumen" => "40" "paginaInicial" => "9" "paginaFinal" => "16" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/20385507" "web" => "Medline" ] ] ] ] ] ] ] ] 22 => array:3 [ "identificador" => "bib0400" "etiqueta" => "23" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Peripheral artery disease as a predictor of coronary artery disease in patients undergoing coronary angiography" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "A. Kumar" 1 => "S. Bano" 2 => "U. Bhurgri" 3 => "J. Kumar" 4 => "A. Ali" 5 => "S. Dembra" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.7759/cureus.15094" "Revista" => array:5 [ "tituloSerie" => "Cureus" "fecha" => "2021" "volumen" => "13" "paginaInicial" => "e15094" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/34159004" "web" => "Medline" ] ] ] ] ] ] ] ] 23 => array:3 [ "identificador" => "bib0405" "etiqueta" => "24" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Relationship of obesity distribution and peripheral arterial occlusive disease in elderly men" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "A. Planas" 1 => "A. Clara" 2 => "J. Pou" 3 => "F. Vidal-Barraquer" 4 => "A. Gasol" 5 => "A. De Moner" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1038/sj.ijo.0801638" "Revista" => array:6 [ "tituloSerie" => "Int J Obes Relat Metab Disord" "fecha" => "2001" "volumen" => "25" "paginaInicial" => "1068" "paginaFinal" => "1070" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/11443508" "web" => "Medline" ] ] ] ] ] ] ] ] 24 => array:3 [ "identificador" => "bib0410" "etiqueta" => "25" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Prevalence of and risk factors for peripheral arterial disease in the United States: results from the National Health and Nutrition Examination Survey, 1999–2000" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "E. Selvin" 1 => "T.P. Erlinger" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1161/01.CIR.0000137913.26087.F0" "Revista" => array:6 [ "tituloSerie" => "Circulation" "fecha" => "2004" "volumen" => "110" "paginaInicial" => "738" "paginaFinal" => "743" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/15262830" "web" => "Medline" ] ] ] ] ] ] ] ] 25 => array:3 [ "identificador" => "bib0415" "etiqueta" => "26" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Sex differences in management and outcomes of critical limb ischemia in the Medicare population" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "A. Mentias" 1 => "M. Vaughan-Sarrazin" 2 => "M. Saad" 3 => "S. Girotra" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1161/CIRCINTERVENTIONS.120.009459" "Revista" => array:5 [ "tituloSerie" => "Circ Cardiovasc Interv" "fecha" => "2020" "volumen" => "13" "paginaInicial" => "e009459" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/33079598" "web" => "Medline" ] ] ] ] ] ] ] ] 26 => array:3 [ "identificador" => "bib0420" "etiqueta" => "27" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Lifetime risk of lower-extremity peripheral artery disease defined by ankle-brachial index in the United States" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "K. Matsushita" 1 => "Y. Sang" 2 => "H. Ning" 3 => "S.H. Ballew" 4 => "E.K. Chow" 5 => "M.E. Grams" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1161/JAHA.119.012177" "Revista" => array:5 [ "tituloSerie" => "J Am Heart Assoc" "fecha" => "2019" "volumen" => "8" "paginaInicial" => "e012177" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/31500474" "web" => "Medline" ] ] ] ] ] ] ] ] 27 => array:3 [ "identificador" => "bib0425" "etiqueta" => "28" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Peripheral arterial disease, prevalence and cumulative risk factor profile analysis" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "L.H. Eraso" 1 => "E. Fukaya" 2 => "E.R. Mohler III" 3 => "D. Xie" 4 => "D. Sha" 5 => "J.S. Berger" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1177/2047487312452968" "Revista" => array:6 [ "tituloSerie" => "Eur J Prev Cardiol" "fecha" => "2014" "volumen" => "21" "paginaInicial" => "704" "paginaFinal" => "711" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22739687" "web" => "Medline" ] ] ] ] ] ] ] ] 28 => array:3 [ "identificador" => "bib0430" "etiqueta" => "29" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Pathophysiology of thrombosis in peripheral artery disease" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "A. Habib" 1 => "G. Petrucci" 2 => "B. Rocca" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Curr Vasc Pharmacol" "fecha" => "2020" "volumen" => "18" "paginaInicial" => "204" "paginaFinal" => "214" ] ] ] ] ] ] 29 => array:3 [ "identificador" => "bib0435" "etiqueta" => "30" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Tissue factor, blood coagulation, and beyond: an overview" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "A.J. Chu" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:4 [ "tituloSerie" => "Int J Inflam" "fecha" => "2011" "volumen" => "2011" "paginaInicial" => "367284" ] ] ] ] ] ] 30 => array:3 [ "identificador" => "bib0440" "etiqueta" => "31" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "General mechanisms of coagulation and targets of anticoagulants (Section I)" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "R. De Caterina" 1 => "S. Husted" 2 => "L. Wallentin" 3 => "F. Andreotti" 4 => "H. Arnesen" 5 => "F. Bachmann" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1160/TH12-10-0772" "Revista" => array:6 [ "tituloSerie" => "Thromb Haemost" "fecha" => "2013" "volumen" => "109" "paginaInicial" => "569" "paginaFinal" => "579" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23447024" "web" => "Medline" ] ] ] ] ] ] ] ] 31 => array:3 [ "identificador" => "bib0445" "etiqueta" => "32" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Early atherosclerosis exhibits an enhanced procoagulant state" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "J.I. Borissoff" 1 => "S. Heeneman" 2 => "E. Kilinç" 3 => "P. Kaššák" 4 => "R. Van Oerle" 5 => "K. Winckers" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1161/CIRCULATIONAHA.109.907121" "Revista" => array:6 [ "tituloSerie" => "Circulation" "fecha" => "2010" "volumen" => "122" "paginaInicial" => "821" "paginaFinal" => "830" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/20697022" "web" => "Medline" ] ] ] ] ] ] ] ] 32 => array:3 [ "identificador" => "bib0450" "etiqueta" => "33" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Pathogenesis of the limb manifestations and exercise limitations in peripheral artery disease" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "W.R. Hiatt" 1 => "E.J. Armstrong" 2 => "C.J. Larson" 3 => "E.P. Brass" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1161/CIRCRESAHA.116.303566" "Revista" => array:7 [ "tituloSerie" => "Circ Res" "fecha" => "2015" "volumen" => "116" "paginaInicial" => "1527" "paginaFinal" => "1539" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/25908726" "web" => "Medline" ] ] "itemHostRev" => array:3 [ "pii" => "S1535610820305961" "estado" => "S300" "issn" => "15356108" ] ] ] ] ] ] ] 33 => array:3 [ "identificador" => "bib0455" "etiqueta" => "34" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "A review of the pathophysiology and potential biomarkers for peripheral artery disease" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "S.M. Krishna" 1 => "J.V. Moxon" 2 => "J. Golledge" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Int J Mol Sci" "fecha" => "2015" "volumen" => "16" "paginaInicial" => "11294" "paginaFinal" => "11322" ] ] ] ] ] ] 34 => array:3 [ "identificador" => "bib0460" "etiqueta" => "35" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Canadian Cardiovascular Society 2022 guidelines for peripheral arterial disease" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "B.L. Abramson" 1 => "M. Al-Omran" 2 => "S.S. Anand" 3 => "Z. Albalawi" 4 => "T. Coutinho" 5 => "C. de Mestral" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.cjca.2022.02.029" "Revista" => array:6 [ "tituloSerie" => "Can J Cardiol" "fecha" => "2022" "volumen" => "38" "paginaInicial" => "560" "paginaFinal" => "587" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/35537813" "web" => "Medline" ] ] ] ] ] ] ] ] 35 => array:3 [ "identificador" => "bib0465" "etiqueta" => "36" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "2017 ESC Guidelines on the Diagnosis and Treatment of Peripheral Arterial Diseases, in collaboration with the European Society for Vascular Surgery (ESVS)" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "V. Aboyans" 1 => "J.B. Ricco" 2 => "M.E.L. Bartelink" 3 => "M. Björck" 4 => "M. Brodmann" 5 => "T. Cohnert" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1093/eurheartj/ehx095" "Revista" => array:7 [ "tituloSerie" => "Eur Heart J" "fecha" => "2018" "volumen" => "39" "paginaInicial" => "763" "paginaFinal" => "816" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/28886620" "web" => "Medline" ] ] "itemHostRev" => array:3 [ "pii" => "S1556086421032846" "estado" => "S300" "issn" => "15560864" ] ] ] ] ] ] ] 36 => array:3 [ "identificador" => "bib0470" "etiqueta" => "37" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "The Edinburgh Claudication Questionnaire: an improved version of the WHO/Rose Questionnaire for use in epidemiological surveys" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "G.C. Leng" 1 => "F.G. Fowkes" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/0895-4356(92)90150-l" "Revista" => array:6 [ "tituloSerie" => "J Clin Epidemiol" "fecha" => "1992" "volumen" => "45" "paginaInicial" => "1101" "paginaFinal" => "1109" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/1474406" "web" => "Medline" ] ] ] ] ] ] ] ] 37 => array:3 [ "identificador" => "bib0475" "etiqueta" => "38" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Measurement and interpretation of the ankle-brachial index: a scientific statement from the American Heart Association" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "V. Aboyans" 1 => "M.H. Criqui" 2 => "P. Abraham" 3 => "M.A. Allison" 4 => "M.A. Creager" 5 => "C. Diehm" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1161/CIR.0b013e318276fbcb" "Revista" => array:6 [ "tituloSerie" => "Circulation" "fecha" => "2012" "volumen" => "126" "paginaInicial" => "2890" "paginaFinal" => "2909" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23159553" "web" => "Medline" ] ] ] ] ] ] ] ] 38 => array:3 [ "identificador" => "bib0480" "etiqueta" => "39" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Guía ESC 2017 sobre el diagnóstico y tratamiento de la enfermedad arterial periférica, desarrollada en colaboración con la European Society for Vascular Surgery (ESVS)" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "V. Aboyans" 1 => "J.-B. Ricco" 2 => "M.-L. Bartelink" 3 => "M. Björck" 4 => "M. Brodmann" 5 => "T. Cohnert" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Rev Esp Cardiol" "fecha" => "2018" "volumen" => "111" "paginaInicial" => "e69" "paginaFinal" => "e71" ] ] ] ] ] ] 39 => array:3 [ "identificador" => "bib0485" "etiqueta" => "40" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Duplex ultrasonography, magnetic resonance angiography, and computed tomography angiography for diagnosis and assessment of symptomatic, lower limb peripheral arterial disease: systematic review" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "R. Collins" 1 => "J. Burch" 2 => "G. Cranny" 3 => "R. Aguiar-Ibáñez" 4 => "D. Craig" 5 => "K. Wright" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:4 [ "tituloSerie" => "BMJ" "fecha" => "2007" "volumen" => "334" "paginaInicial" => "1257" ] ] ] ] ] ] 40 => array:3 [ "identificador" => "bib0490" "etiqueta" => "41" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "A meta-analysis of randomized controlled trials evaluating the efficacy of smoking cessation interventions in people with peripheral artery disease" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "S. Thanigaimani" 1 => "A. Drovandi" 2 => "J. Golledge" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.jvs.2021.07.248" "Revista" => array:6 [ "tituloSerie" => "J Vasc Surg" "fecha" => "2022" "volumen" => "75" "paginaInicial" => "721" "paginaFinal" => "729.e7" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/34600029" "web" => "Medline" ] ] ] ] ] ] ] ] 41 => array:3 [ "identificador" => "bib0495" "etiqueta" => "42" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Exercise for intermittent claudication" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "R. Lane" 1 => "A. Harwood" 2 => "L. Watson" 3 => "G.C. Leng" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1002/14651858.CD000990.pub4" "Revista" => array:5 [ "tituloSerie" => "Cochrane Database Syst Rev" "fecha" => "2017" "volumen" => "12" "paginaInicial" => "CD000990" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/29278423" "web" => "Medline" ] ] ] ] ] ] ] ] 42 => array:3 [ "identificador" => "bib0500" "etiqueta" => "43" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "2019 ESC/EAS Guidelines for the management of dyslipidaemias: lipid modification to reduce cardiovascular risk: the Task Force for the management of dyslipidaemias of the European Society of Cardiology (ESC) and European Atherosclerosis Society (EAS)" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "F. Mach" 1 => "C. Baigent" 2 => "A.L. Catapano" 3 => "K.C. Koskinas" 4 => "M. Casula" 5 => "L. Badimon" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Eur Heart J" "fecha" => "2020" "volumen" => "41" "paginaInicial" => "111" "paginaFinal" => "188" ] ] ] ] ] ] 43 => array:3 [ "identificador" => "bib0505" "etiqueta" => "44" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "MRC/BHF Heart Protection Study of cholesterol lowering with simvastatin in 20 536 high-risk individuals: a randomised placebocontrolled trial" "autores" => array:1 [ 0 => array:2 [ "colaboracion" => "HPSC Group" "etal" => false ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/S0140-6736(02)09327-3" "Revista" => array:6 [ "tituloSerie" => "Lancet" "fecha" => "2002" "volumen" => "360" "paginaInicial" => "7" "paginaFinal" => "22" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/12114036" "web" => "Medline" ] ] ] ] ] ] ] ] 44 => array:3 [ "identificador" => "bib0510" "etiqueta" => "45" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Statin therapy and long-term adverse limb outcomes in patients with peripheral artery disease: insights from the REACH registry" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "D.J. Kumbhani" 1 => "P.G. Steg" 2 => "C.P. Cannon" 3 => "K.A. Eagle" 4 => "S.C. Smith Jr." 5 => "S. Goto" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1093/eurheartj/ehu080" "Revista" => array:6 [ "tituloSerie" => "Eur Heart J" "fecha" => "2014" "volumen" => "35" "paginaInicial" => "2864" "paginaFinal" => "2872" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/24585266" "web" => "Medline" ] ] ] ] ] ] ] ] 45 => array:3 [ "identificador" => "bib0515" "etiqueta" => "46" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Guía práctica sobre el diagnóstico y tratamiento de la hipertensión arterial en España, 2022. Sociedad Española de Hipertensión-Liga Española para la Lucha contra la Hipertensión Arterial (SEH-LELHA)" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "M. Gorostidi" 1 => "T. Gijón-Conde" 2 => "A. De La Sierra" 3 => "E. Rodilla" 4 => "E. Rubio" 5 => "E. Vinyoles" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.hipert.2022.09.002" "Revista" => array:6 [ "tituloSerie" => "Hipertens Riesgo Vasc" "fecha" => "2022" "volumen" => "39" "paginaInicial" => "174" "paginaFinal" => "194" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/36153303" "web" => "Medline" ] ] ] ] ] ] ] ] 46 => array:3 [ "identificador" => "bib0520" "etiqueta" => "47" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "2018 ESC/ESH Guidelines for the management of arterial hypertension: the Task Force for the management of arterial hypertension of the European Society of Cardiology (ESC) and the European Society of Hypertension (ESH)" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "B. Williams" 1 => "G. Mancia" 2 => "W. Spiering" 3 => "E. Agabiti Rosei" 4 => "M. Azizi" 5 => "M. Burnier" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1093/eurheartj/ehy339" "Revista" => array:6 [ "tituloSerie" => "Eur Heart J" "fecha" => "2018" "volumen" => "39" "paginaInicial" => "3021" "paginaFinal" => "3104" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/30165516" "web" => "Medline" ] ] ] ] ] ] ] ] 47 => array:3 [ "identificador" => "bib0525" "etiqueta" => "48" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Anti-hypertensive treatment in peripheral artery disease" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "C. Tsioufis" 1 => "I. Andrikou" 2 => "G. Siasos" 3 => "K. Filis" 4 => "D. Tousoulis" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.coph.2018.01.009" "Revista" => array:6 [ "tituloSerie" => "Curr Opin Pharmacol" "fecha" => "2018" "volumen" => "39" "paginaInicial" => "35" "paginaFinal" => "42" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/29459079" "web" => "Medline" ] ] ] ] ] ] ] ] 48 => array:3 [ "identificador" => "bib0530" "etiqueta" => "49" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Association of elevated fasting glucose with lower patency and increased major adverse limb events among patients with diabetes undergoing infrapopliteal balloon angioplasty" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "S. Singh" 1 => "E.J. Armstrong" 2 => "W. Sherif" 3 => "B. Alvandi" 4 => "G.G. Westin" 5 => "G.D. Singh" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1177/1358863X14538330" "Revista" => array:6 [ "tituloSerie" => "Vasc Med" "fecha" => "2014" "volumen" => "19" "paginaInicial" => "307" "paginaFinal" => "314" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/24939930" "web" => "Medline" ] ] ] ] ] ] ] ] 49 => array:3 [ "identificador" => "bib0535" "etiqueta" => "50" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Antithrombotic therapy in patients with peripheral artery disease: a focused review on oral anticoagulation" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "J.M. Rivera-Caravaca" 1 => "A. Camelo-Castillo" 2 => "I. Ramírez-Macías" 3 => "P. Gil-Pérez" 4 => "C. López-García" 5 => "M.A. Esteve-Pastor" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.3390/ijms22137113" "Revista" => array:5 [ "tituloSerie" => "Int J Mol Sci" "fecha" => "2021" "volumen" => "22" "paginaInicial" => "7113" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/34281167" "web" => "Medline" ] ] ] ] ] ] ] ] 50 => array:3 [ "identificador" => "bib0540" "etiqueta" => "51" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "2016 AHA/ACC guideline on the management of patients with lower extremity peripheral artery disease: executive summary: a report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "M.D. Gerhard-Herman" 1 => "H.L. Gornik" 2 => "C. Barrett" 3 => "N.R. Barshes" 4 => "M.A. Corriere" 5 => "D.E. Drachman" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1161/CIR.0000000000000470" "Revista" => array:6 [ "tituloSerie" => "Circulation" "fecha" => "2017" "volumen" => "135" "paginaInicial" => "e686" "paginaFinal" => "e725" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/27840332" "web" => "Medline" ] ] ] ] ] ] ] ] 51 => array:3 [ "identificador" => "bib0545" "etiqueta" => "52" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Rivaroxaban with or without aspirin in stable cardiovascular disease" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "J.W. Eikelboom" 1 => "S.J. Connolly" 2 => "J. Bosch" 3 => "G.R. Dagenais" 4 => "R.G. Hart" 5 => "O. Shestakovska" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "N Engl J Med" "fecha" => "2017" "volumen" => "377" "paginaInicial" => "1319" "paginaFinal" => "1330" ] ] ] ] ] ] 52 => array:3 [ "identificador" => "bib0550" "etiqueta" => "53" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Rationale and design for the Vascular Outcomes study of ASA along with rivaroxaban in endovascular or surgical limb revascularization for peripheral artery disease (VOYAGER PAD)" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "W.H. Capell" 1 => "M.P. Bonaca" 2 => "M.R. Nehler" 3 => "E. Chen" 4 => "J.M. Kittelson" 5 => "S.S. Anand" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.ahj.2018.01.011" "Revista" => array:6 [ "tituloSerie" => "Am Heart J" "fecha" => "2018" "volumen" => "199" "paginaInicial" => "83" "paginaFinal" => "91" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/29754671" "web" => "Medline" ] ] ] ] ] ] ] ] 53 => array:3 [ "identificador" => "bib0555" "etiqueta" => "54" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Major adverse limb events and mortality in patients with peripheral artery disease: the COMPASS trial" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "S.S. Anand" 1 => "F. Caron" 2 => "J.W. Eikelboom" 3 => "J. Bosch" 4 => "L. Dyal" 5 => "V. Aboyans" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "J Am Coll Cardiol" "fecha" => "2018" "volumen" => "71" "paginaInicial" => "2306" "paginaFinal" => "2315" ] ] ] ] ] ] 54 => array:3 [ "identificador" => "bib0560" "etiqueta" => "55" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Rivaroxaban in peripheral artery disease after revascularization" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "M.P. Bonaca" 1 => "R.M. Bauersachs" 2 => "S.S. Anand" 3 => "E.S. Debus" 4 => "M.R. Nehler" 5 => "M.R. Patel" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1056/NEJMoa2000052" "Revista" => array:6 [ "tituloSerie" => "N Engl J Med" "fecha" => "2020" "volumen" => "382" "paginaInicial" => "1994" "paginaFinal" => "2004" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/32222135" "web" => "Medline" ] ] ] ] ] ] ] ] 55 => array:3 [ "identificador" => "bib0565" "etiqueta" => "56" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Surgical intervention for peripheral arterial disease" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "S.M. Vartanian" 1 => "M.S. Conte" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1161/CIRCRESAHA.116.303504" "Revista" => array:6 [ "tituloSerie" => "Circ Res" "fecha" => "2015" "volumen" => "116" "paginaInicial" => "1614" "paginaFinal" => "1628" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/25908732" "web" => "Medline" ] ] ] ] ] ] ] ] 56 => array:3 [ "identificador" => "bib0570" "etiqueta" => "57" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Bypass versus angioplasty in severe ischaemia of the leg (BASIL): multicentre, randomised controlled trial" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "A.W. Bradbury" 1 => "C. Ruckley" 2 => "F. Fowkes" 3 => "J. Forbes" 4 => "I. Gillespie" 5 => "D. Adam" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/S0140-6736(05)67704-5" "Revista" => array:6 [ "tituloSerie" => "Lancet" "fecha" => "2005" "volumen" => "366" "paginaInicial" => "1925" "paginaFinal" => "1934" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/16325694" "web" => "Medline" ] ] ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/00257753/0000016100000008/v1_202310180449/S0025775323003615/v1_202310180449/en/main.assets" "Apartado" => array:4 [ "identificador" => "64287" "tipo" => "SECCION" "es" => array:2 [ "titulo" => "Revisión" "idiomaDefecto" => true ] "idiomaDefecto" => "es" ] "PDF" => "https://static.elsevier.es/multimedia/00257753/0000016100000008/v1_202310180449/S0025775323003615/v1_202310180449/en/main.pdf?idApp=UINPBA00004N&text.app=https://www.elsevier.es/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0025775323003615?idApp=UINPBA00004N" ]
Journal Information
Review
Peripheral artery disease: Update on etiology, pathophysiology, diagnosis and treatment
Enfermedad arterial periférica: Actualización en etiología, fisiopatología, diagnóstico y tratamiento