Atherosclerotic Occlusive Disease of the Lower Extremities

The SVS recommends using the ABI as the first-line noninvasive test to establish a diagnosis of PAD in individuals with symptoms or signs suggestive of disease. When the ABI is borderline or normal (>0.9) and symptoms of claudication are suggestive, the SVS recommends an exercise ABI. ( S , A )

The SVS suggests against routine screening for lower extremity PAD in the absence of risk factors, history, signs, or symptoms of PAD. ( W , A )

For asymptomatic individuals who are at elevated risk, such as those aged >70, smokers, diabetic patients, those with an abnormal pulse examination, or other established cardiovascular disease, screening for lower extremity PAD is reasonable if used to improve risk stratification, preventive care, and medical management. ( W , A )

In symptomatic patients who are being considered for revascularization, the SVS suggests using physiologic noninvasive studies, such as segmental pressures and pulse volume recordings, to aid in the quantification of arterial insufficiency and help localize the level of obstruction. ( W , A )

In symptomatic patients in whom revascularization treatment is being considered, the SVS recommends anatomic imaging studies, such as arterial duplex ultrasound, computed tomography angiography, magnetic resonance angiography, and contrast arteriography. ( S , B )

The SVS recommends multidisciplinary comprehensive smoking cessation interventions for patients with asymptomatic PAD who use tobacco (repeatedly until tobacco use has stopped). ( S , A )

The SVS recommends providing education about the signs and symptoms of PAD progression to asymptomatic patients with PAD. ( S , U )

The SVS recommends against invasive treatments for PAD in the absence of symptoms, regardless of hemodynamic measures or imaging findings demonstrating PAD. ( S , B )