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 loweror 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 (lowerand 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