Hosted by Ray Shields, MD

Peripheral arterial disease (PAD), or atherosclerosis affecting the limbs, can lead to disabling symptoms of claudication or critical limb ischemia threatening limb viability. Moreover, PAD is a marker of systemic atherosclerosis; as a result, patients are at increased risk for myocardial infarction, stroke, and death. Risk factors associated with PAD include older age, cigarette smoking, diabetes, hypercholesterolemia, hypertension, and possibly genetic factors.

 Initial screening for PAD should include a history for claudication and an assessment of pedal pulses. As many patients with PAD are asymptomatic, an ankle brachial index (ABI) may be considered in the evaluation of suspected PAD. The ABI, a ratio of Doppler-recorded systolic pressures in the lower and upper extremities, is a simple and accurate noninvasive test for the screening and diagnosis of PAD.  Both the sensitivity and specificity of ankle brachial index less than 0.9 (the accepted cut-off for the presence of PAD) is about 95% for detecting angiographic arterial disease. Data from the Strong Heart Study suggest that the upper limit of normal ABI should not exceed 1.40. Patients with significant or positive ABI should be referred for further vascular assessment and exercise, medications, and surgical options should be considered.

 Smoking cessation and lipid-lowering agents improve claudication symptoms and lower extremity functioning among patients with symptomatic PAD. Smoking cessation and physical activity training also increase maximal walking distance among men with early PAD. In the Appropriate Blood Pressure Control in Diabetes (ABCD) Trial, intensive blood pressure control was shown to be effective in reducing the risk of fatal and nonfatal CVD events among adults with diabetes.