GENERAL DISCUSSION & SUMMARY
Peripheral arterial disease (PAD) is an expression of systemic atherosclerosis. Plaque formation causes progressive narrowing and hardening of the arteries. The manifestation of PAD is diverse. The vast majority of individuals are asymptomatic whereas only a small portion of patients develops tissue loss that necessitates amputation of the affected limb.
Globally, 202 million people are affected by PAD. The disease is found in 19% of the Dutch population >55 years.1,2 Between 2000 and 2010, the number of patients with PAD has increased by nearly a quarter in first, second and third world countries1. In view of the association of PAD with loss of mobility, functional decline and cardiovascular events, this dramatic increase represents a major public health challenge. Recently, a call for governments, nongovernmental organizations and the private sector was made to address the social and economic consequences of PAD and to assess the best strategies for optimum treatment and prevention of this disease.1
Most PAD patients suffer from intermittent claudication (IC).3 IC is defined as muscle discomfort in the lower limb reproducibly evoked by exercise and relieved by <10 minutes rest.3 Most patients with IC are physically impaired. Therefore, treatment goals are to relieve symptoms and to improve exercise performance and daily functional abilities.