Peripheral arterial disease: a review of disease awareness and management

Peripheral arterial disease (PAD) is a progressive atherosclerotic condition affecting approximately 27 million people in North America and Europe. Albeit a common clinical malady, it is underrecognized and undertreated.

The goal of this article was to review the pathophysiology, clinical implications, diagnosis, and management of PAD.

Relevant published information was identified through a search of MEDLINE (1966-2006). Search terms used included peripheral vascular diseases, intermittent claudication, arterial occlusive diseases, antiplatelet therapy, HMG-CoA reductase inhibitors, risk factors, smoking cessation, adrenergic beta-antagonists, and angiotensin-converting enzymes.

PAD is associated with an increased risk of cardiovascular and cerebrovascular disease as well as a reduction in quality of life. PAD symptoms are not always present with the disease; therefore, improvements in screening methods for at-risk patients are necessary. Patients at risk for PAD should be routinely screened, and appropriate management--including antiplatelet therapy and risk factor modifications--should be initiated once the disease is recognized. Risk factor modifications should include smoking cessation as well as blood pressure and cholesterol management. Acetylsalicylic acid (ASA) is the antiplatelet of choice, and clopidogrel should be used as an alternative if ASA therapy is contraindicated or an intolerance is present. Cilostazol has a minimal role for the symptomatic relief in patients with disabling intermittent claudication. All patients with PAD should be treated with a 3-hydroxy-3-methylglutaryl coenzyme A reductase inhibitor and potentially an angiotensin-converting enzyme inhibitor. Beta-Blockers should not be avoided unless documented worsening of symptoms is associated with their use.

Patients at risk for PAD should be routinely screened, and appropriate management including antiplatelet therapy and risk factor modifications should be initiated once the disease is recognized.