Cardiovascular Disease: Lower Extremity Peripheral Artery Disease

Lower extremity peripheral artery disease (PAD) refers to atherosclerotic disease that involves the iliac, femoral, or more distal arteries of the lower extremities. This condition affects 8 to 12 million Americans. Risk factors include advanced age, hypertension, dyslipidemia, diabetes, and cigarette smoking. Approximately 10% to 30% of patients with PAD present with the classic symptom of intermittent claudication. Some patients experience symptoms such as pallor, hair loss, or nonhealing wounds, and up to half of patients are asymptomatic. There are differing recommendations from various organizations for screening of asymptomatic patients. If PAD is suspected, the ankle-brachial index is the preferred first test. Further tests, including duplex ultrasonography or angiography, may be warranted depending on the clinical situation. Therapy for patients with PAD consists of lifestyle modifications, which include diet modification, exercise programs, and smoking cessation. Medical therapy consists of antiplatelet and statin therapies for secondary prevention of vascular complications, and consideration of drugs such as cilostazol for symptom control. Patients with acute limb ischemia should be referred emergently for evaluation and possible revascularization. Patients with lifestyle-limiting claudication despite lifestyle modification and medical therapy and patients with chronic limb ischemia (eg, nonhealing wounds) should be considered for revascularization.