Peripheral arterial disease: considerations in risks, diagnosis, and treatment

Peripheral arterial disease (PAD), a manifestation of systemic atherosclerosis, is a marker for coronary artery, cerebrovascular, and renal artery atherosclerotic vascular disease. Patients with PAD have an increased risk of cardiovascular events such as myocardial infarction and stroke in addition to significant impairment in their quality of life and physical function. Early detection and implementation of guideline-recommended therapies are paramount to effective treatment of PAD. Measurement of the ankle-brachial index is a simple, reliable, and noninvasive test to diagnose PAD that can be used in a primary care setting. Lifestyle modification, including exercise and smoking cessation, combined with pharmacologic therapy to manage risk factors have been shown effective in reducing cardiovascular risks in patients with PAD. Evidence suggests, however, that there is currently a lack of awareness regarding PAD among physicians and patients, leading to underdiagnosis and undertreatment. This paper reviews the epidemiology, pathology, and clinical implications of PAD, and offers current evidence for disease management quality improvement initiatives to enhance patient care.