What is peripheral arterial disease?
Peripheral arterial disease (PAD), also known as peripheral vascular disease, is the reduced circulation of blood to a body part outside of the heart or brain.
PAD occurs most commonly in the arteries leading to the legs and feet. It is often the result of atherosclerosis, where fatty deposits build up in the walls of arteries. In some people it does not present any symptoms, while others may experience pain at rest or while walking. In severe cases it can lead to tissue loss, and the amputation of a limb.
A notable form of PAD is abdominal aortic aneurysm. This is abnormal widening of the aorta (the main artery leading from the heart) below the level of the diaphragm. It can be a life-threatening condition if the arterial wall ruptures. Surgery is necessary in some cases.
Tobacco smoking and diabetes are primary risk factors for PAD. Type 2 diabetes in people with PAD can accelerate atherosclerosis, and increase the risk of amputation, of other cardiac events such as stroke, and death.
Other PAD risk factors include abnormal blood lipids, high blood pressure, overweight or obesity, and family history of the disease. PAD has increasingly been associated with other chronic conditions such as atrial fibrillation, heart failure, obstructive sleep apnoea and chronic kidney disease.
How many Australians have peripheral arterial disease?
Currently, there are no national data on the number of Australians who have PAD.
PAD has been estimated to affect up to 10% of patients in primary care settings, and over 20% when studied in populations aged 75 and over (Aitken 2020, Conte & Vale 2018). Over half of all people with PAD show no symptoms, leading to under-diagnosis and under-treatment.
Peripheral arterial disease often occurs alongside other chronic diseases, so both the principal and additional diagnoses of PAD should be counted when estimating its contribution to hospitalisations.
There were around 59,100 hospitalisations where PAD was recorded as the principal and/or additional diagnosis in 2020–21. This represents 0.5% of all hospitalisations in Australia.
PAD was recorded as the principal diagnosis in 56% (33,200) of these hospitalisations.
Over half of all hospitalisations where PAD was the principal diagnosis (60%) were for atherosclerosis of the peripheral arteries, while abdominal aortic aneurysm accounted for a further 9%. The remainder was comprised largely of embolisms and other aneurysms.
Age and sex
Where PAD was recorded as the principal and/or additional diagnosis, hospitalisation rates:
- were overall twice as high for males as females (age-standardised rates of 251 and 127 per 100,000 population). Age-specific rates were higher among males than females in all age groups, except for age 35–44 (48 and 49 per 100,000 population)
- increased with age, with rates highest for males and females aged 85 and over (2,500 and 1,600 per 100,000 population)―at least 1.4 times as high as those aged 75–84 (1,800 and 910 per 100,000) (Figure 1).
Figure 1: Peripheral arterial disease hospitalisation rates, principal and/or additional diagnosis, by age and sex, 2020–21