Cardiovascular Disease Update: Peripheral Artery Disease

Peripheral artery disease (PAD) is caused by atherosclerosis that leads to the narrowing or obstruction of the peripheral arteries, most commonly those that supply blood to the legs. The classic symptom is intermittent claudication-reproducible pain in the lower extremities consistently induced by exercise and relieved with rest. However, only about 10% of patients with PAD present with classic symptoms of claudication. Patients who have symptoms suggestive of PAD should undergo diagnostic testing using the ankle-brachial index (ABI). An ABI value of 0.9 or less is consistent with a diagnosis of PAD. An exercise ABI should be considered if ABI is normal and there is a high clinical suspicion for PAD. An ABI of 1.4 or greater is considered inconclusive or noncompressible and warrants further evaluation with alternative testing. This is most common in patients with diabetes and end-stage renal disease. Treatment for PAD includes structured exercise therapy, a single antiplatelet medication (clopidogrel preferred), a high-intensity statin, blood pressure control, antidiabetic agents (glucagon-like peptide-1 receptor agonists and sodium-glucose cotransporter-2 inhibitors), and smoking cessation when applicable. Patients who do not improve with initial treatment and those with chronic limb-threatening ischemia should be evaluated for revascularization, using imaging to determine the location and severity of arterial disease. Patients with acute limb ischemia require urgent evaluation to preserve limb viability.