Atherosclerotic Peripheral Vascular Disease Symposium II
Nomenclature for Vascular Diseases
Peripheral vascular diseases are important components of cardiovascular medicine. The high prevalence of these disorders in the clinical setting mandates effective communication among healthcare providers. The public health significance of these conditions requires clear and consistent terminology for community audiences. Therefore, the goal of this writing group was to suggest definitions, usage, and nomenclature of specific terms commonly used to describe vascular diseases by cardiovascular specialists and primary care communities. The need for clarity is driven by 2 major challenges: (1) the need for use of common keywords for literature searches; and (2) the need for healthcare professionals to use common, reasoned terminology when communicating with each other and with the public. The major structural components of the vascular system are the veins, lymphatic vessels, and arteries. These serve as the basis of the nomenclature system for vascular diseases (Figure).
In this report, the writing group focuses only on nomenclature that applies to non–coronary artery diseases. Venous and lymphatic diseases were outside the scope of this conference. Diseases of arteries are classified further into atherosclerotic occlusive disorders, nonatherosclerotic occlusive disorders, and aneurysms. Atherosclerotic diseases have been subdivided into coronary, cerebral, peripheral, renal, and mesenteric disorders.
Specific terminology for vascular diseases is provided in Table 1. The term “vascular diseases” should refer to all diseases of arteries, veins, and lymphatic vessels. Coronary artery disease was not included in Table 1 because it was outside the scope of this conference. “Atherosclerotic vascular diseases” refers to diseases of arteries caused by atherosclerosis. The term “peripheral artery disease” (PAD) is recommended to describe disease that affects the lower- or upper-extremity arteries. PAD should replace “peripheral vascular disease,” which was often used in the past to describe leg artery disease but was too nonspecific, given that it can encompass venous in addition to arterial disorders. Table 1 provides additional definitions for atherosclerotic vascular diseases as they apply to the noncoronary circulations. Definitions are provided for peripheral (lower- and upper-extremity), mesenteric (celiac, superior mesenteric, and inferior mesenteric arteries), and renal and cerebral artery (intracranial and extracranial) disease. These are further subdivided into the major manifestations of each disease. Universal use of the term “disease” is preferred rather than the selective use of the term “stenosis,” for example, “renal artery disease” rather than “renal artery stenosis.” This is because an artery can have an occlusion or a stenosis with similar clinical manifestations, and the term “disease” is meant to cover both conditions. Some causes of these arterial diseases are provided in Table 1.
In addition to atherosclerosis, a number of nonatherosclerotic arterial occlusive diseases affect peripheral vessels. These include fibromuscular dysplasia, popliteal artery entrapment, popliteal adventitial cyst, thoracic outlet syndrome, vasculitis, radiation injury, and trauma.
Table 2 provides terminology for aneurysms of the aorta and its visceral and limb branches. Although the definitions vary, an artery can be considered aneurysmal when its diameter is increased by 50% compared with the normal dimension.
Table 3 defines several terms for the clinical manifestations of PAD. Many patients with PAD are “asymptomatic” on the basis of the absence of exertional leg symptoms. The classic symptom is termed “intermittent claudication,” defined as effort-induced (usually walking) discomfort of the calf, thigh, and/or buttock, variably described as cramping, aching, tightness, pain, or fatigue. “Atypical claudication” refers to exertional leg pain that does not fulfill all the characteristics of classic claudication.
Many patients have functional limitations characterized by slow walking speed or limited walking endurance but without typical or atypical claudication symptoms. These patients are functionally limited, which, like silent coronary ischemia, implies an underlying cardiovascular disease with important clinical sequelae.
Table 4 defines several terms commonly used in the measurement and treatment of PAD with reference to artery revascularization and repair. Typical noninvasive evaluation is based on hemodynamic measures, such as systolic pressures taken at the ankle or toe. Objective measures of functional limitations in patients with claudication are based on treadmill testing. Treatment includes endovascular and open (surgical) repair of arteries. Terms for these tests and treatments are proposed.
Potential conflicts of interest for members of the writing groups for all sections of these conference proceedings are provided in a disclosure table included with the Executive Summary, which is available online at http://circ.ahajournals.org/cgi/reprint/118/25/2811.
The American Heart Association makes every effort to avoid any actual or potential conflicts of interest that may arise as a result of an outside relationship or a personal, professional, or business interest of a member of the writing panel. Specifically, all members of the writing group are required to complete and submit a Disclosure Questionnaire showing all such relationships that might be perceived as real or potential conflicts of interest.
The opinions expressed in this manuscript are those of the authors and are not necessarily those of the editors or the American Heart Association.
The Executive Summary and other writing group reports for these proceedings are available online at http://circ.ahajournals.org (Circulation. 2008;118:2811–2825; 2830–2836; 2837–2844; 2845–2851; 2852–2859; 2860–2863; 2864–2872; and 2873–2878).
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