Screening and Early Diagnosis of Asymptomatic Peripheral Artery Disease

Asymptomatic peripheral artery disease (PAD), present in 50 to 70% of all PAD cases, carries substantial cardiovascular and limb-related risks, yet remains clinically underrecognized. Despite a low ankle-brachial index (ABI) predicting 1.5- to 2.5-fold increased cardiovascular mortality and progressive limb disease, the translation from detection to clinical benefit remains uncertain. The 2018 U.S. Preventive Services Task Force concluded that the evidence is insufficient to support universal ABI screening in asymptomatic adults. This narrative review synthesized evidence on asymptomatic PAD screening and early diagnosis via PubMed/MEDLINE search (inception to December 2025) and targeted review of guidelines, high-quality evidence, with priority given to randomized trials, observational cohorts, systematic reviews, and meta-analyses addressing test performance, feasibility, and linkage of detection to actionable care pathways. Asymptomatic PAD affects 8.5 million Americans and 200 million people globally, with highest prevalence in African-American populations (27-30% lifetime risk). Low ABI independently predicts cardiovascular mortality, major adverse events, and impaired functional capacity. Risk-stratified screening demonstrates cost-effectiveness, though medial arterial calcification limits ABI reliability in diabetes and chronic kidney disease. No large randomized trials directly demonstrate that screening-detected PAD, when coupled with structured intervention, improves clinical outcomes. Early detection of asymptomatic PAD identifies high-risk patients warranting intensive preventive therapy. Targeted screening in high-risk populations appears reasonable; however, systematic implementation requires validated protocols, clear interpretation algorithms, and proven downstream care pathways. Outcome-driven trials directly testing screening-based interventions remain essential to resolve the screening debate.