Lower Extremity Peripheral Artery Disease: Diagnosis and Treatment

Area of Science:

• Vascular Medicine
• Cardiovascular Health
• Epidemiology

Background:

• Lower extremity peripheral artery disease (PAD) impacts 12-20% of Americans aged 60 and older.
• Key risk factors include hyperlipidemia, hypertension, diabetes mellitus, chronic kidney disease, and smoking, with three or more factors increasing PAD risk tenfold.
• Classic intermittent claudication affects only 10% of PAD patients; 50% experience other leg symptoms, and 40% are asymptomatic.

Purpose of the Study:

• To outline current guidelines for diagnosing and managing lower extremity peripheral artery disease (PAD).
• To emphasize the importance of risk factor management and appropriate diagnostic testing.
• To detail recommended treatment strategies, including lifestyle modifications, medications, and surgical interventions.

Main Methods:

• Review of current guidelines for PAD diagnosis and management.
• Emphasis on ankle-brachial index (ABI) testing for symptomatic patients.
• Discussion of treatment modalities including lifestyle changes, pharmacotherapy, and surgical revascularization.

Main Results:

• Resting ABI is recommended for patients with suspected PAD; exercise ABI is used for those with normal resting ABI but suggestive symptoms.
• Routine ABI screening is not advised for asymptomatic individuals without increased risk.
• Treatment involves lifestyle modifications (smoking cessation, exercise), secondary prevention medications (antiplatelets, ACE inhibitors/ARBs, statins), and consideration of surgical revascularization for refractory cases.

Conclusions:

• PAD is a common condition in older adults with significant risk factors.
• Diagnosis relies on ABI testing, with specific indications for resting and exercise tests.
• Comprehensive management includes lifestyle changes, medication, and timely referral for surgical intervention when necessary, especially in cases of limb-threatening ischemia.