Marc Schermerhorn, MD, Division of Vascular and Endovascular Surgery, Beth Israel Deaconess Medical Center, Boston, MA, USA.
Kristina Giles, MD, Beth Israel Deaconess Medical Center, Boston, MA, USA.

Peripheral arterial disease (PAD) is a common disorder among older adults. Recognition of the signs and symptoms and appropriate referral of patients to a vascular surgeon can improve functional outcomes and limb salvage. Behavioural, medical, and percutaneous endovascular or open surgical therapies may all be used, depending upon the severity of symptoms and likelihood of limb loss. Cardiovascular comorbidities are common with PAD, and appropriate treatment to minimize cardiovascular mortality is important.
Key words: peripheral arterial disease, claudication, critical limb ischemia, endovascular treatment, lower extremity bypass.

Charles D. Ray, MD, FACS, FRSH (Lond.), President, American College of Spine Surgery; President, International Spine Arthroplasty Society; Past President, North American Spine Society, Yorktown, VA, USA.

Stenoses, or nerve entrapment, can occur at several sites. The focus here is on lumbar spine segments. Compression by stenosis can exist wherever nerve tissue is protectively covered by bone or where thick ligaments are located adjacent to nerve. Overgrowth of bone by spurs is the most common cause of compression producing disability and pain. Neurologic changes are rare. Diagnostic radiological imaging is needed, sometimes aided by selective injections of medications. Due to the limitations of non-surgical treatment, surgical decompression is common with generally good results.
Key words: spinal stenosis, vertebral bone spurs, claudication, surgical decompression, nerve injections.

Ernane D. Reis, MD, Assistant Professor, Department of Surgery, Mount Sinai School of Medicine, New York, NY.
Nicholas Morrissey, MD, Assistant Professor, Department of Surgery, Mount Sinai School of Medicine, New York, NY.

Prevalence of peripheral arterial disease (PAD) increases with age. PAD is not only associated with disability (e.g., claudication, limb loss), but also with increased mortality from cardiac and cerebrovascular events. A thorough assessment of symptoms, risk factors and physical signs--including ankle-brachial indices--can be sufficient to determine whether PAD is present. Further testing--such as Duplex examination, magnetic resonance imaging and conventional arteriography--is often required to determine progression and accurate localization of lesions, as well as to direct therapeutic intervention. Early detection of PAD can help prevent functional impairment and death in the elderly.
Key words: atherosclerosis, peripheral arterial disease, ankle-brachial index, diabetes, claudication.