Peripheral Artery Disease Lower Extremity
Key Points
Key Points
- Lower extremity peripheral artery disease (PAD) is a common cardiovascular disease that is estimated to affect approximately 8.5 million Americans above the age of 40 years and is associated with significant morbidity, mortality, and quality of life (QoL) impairment.
- It has been estimated that 202 million people worldwide have PAD.
Diagnosis
...Diagno...
...finition of PAD Key TermsHaving trouble viewi...
...2. Patients at Increased Risk of PADHaving tro...
Table 3. History and/or Physical Exam...
...Table 4....
...increased risk of PAD (Table 2) should undergo a...
...t increased risk of PAD (Table 2) should...
...h PAD should undergo noninvasive blood press...
...Table 5. Resting ABI for...
...history or physical examination find...
Resting ABI results should be reported as...
...ients at increased risk of PAD (Table 2) but wi...
...at increased risk of PAD (Table 2) a...
...Table 6. Ph...
...ld be measured to diagnose patients with suspect...
...h exertional non–joint-related leg symp...
...ients with PAD and an abnormal resting ABI...
...normal (1.00–1.40) or borderline (0...
...h PAD with an abnormal ABI (≤0.90) or with...
...lternative Diagnoses for Leg Pain or...
...ative Diagnoses for Non-healing Woun...
.... Diagnostic Testing for Suspected PAD...
...igure 2. Diagnostic Testing for Suspected...
...Table 9. Imaging for...
...ex ultrasound, computed tomography angiography...
...ive angiography is useful for patients with...
...raphy is reasonable for patients with lifestyle-...
...d noninvasive angiography (i.e., CTA, MRA...
...Table 10. Abdominal Aort...
...screening duplex ultrasound for AAA is r...
Treatment
Treatm...
...Table 11. Antiplatelet...
...ntiplatelet therapy with aspirin alone (ran...
...tomatic patients with PAD (ABI ≤0...
...c patients with borderline ABI (0.91–0.99...
...tiveness of dual-antiplatelet therapy (DAPT) (asp...
...irin and clopidogrel) may be reasona...
...inical benefit of vorapaxar added to existing...
...Table 12. Sta...
...with a statin medication is indicated for all p...
...Tab...
...tihypertensive therapy should be a...
...tensin-converting enzyme inhibitors o...
...Table 14. Smoking...
...atients with PAD who smoke cigarette...
...ents with PAD who smoke cigarettes should be a...
...with PAD should avoid exposure to environmental...
...Table 15. Glycemic C...
...f diabetes mellitus in the patient with PAD sho...
...ol can be beneficial for patients with CLI to...
...Table...
...of anticoagulation to improve patency aft...
...nticoagulation should NOT be used to r...
...Table 17. Recommen...
...stazol is an effective therapy to improve...
...Table 1...
...e is not effective for treatment of claudication...
...Table 19. Re...
...n therapy (e.g., ethylenediaminetetraaceti...
...n supplementation to lower homocysteine levels...
...Table...
...s with PAD should have an annual influenz...
...Table 22. Struct...
...n patients with claudication, a supervised exercis...
...rcise program should be discussed as a treatment o...
...s with PAD, a structured community...
...with claudication, alternative strategies of...
...tructured Exercise Programs for PAD: De...
Table 24. M...
...h PAD and diabetes mellitus should be counseled...
...s with PAD, prompt diagnosis and treatmen...
...tients with PAD and signs of foot infection, p...
...is reasonable to counsel patients...
...nual foot examination by a clinician is rea...
...able 25. Interdisciplinary Care Team for...
...Table...
...tion is a reasonable treatment option for t...
...Table 27. Endovascular...
...ular procedures are effective as a revasculari...
...cedures are reasonable as a revascularization opti...
...fulness of endovascular procedures as a revasc...
...procedures should NOT be performed in...
Table 28....
...l revascularization is performed, bypass to...
...cedures are reasonable as a revascularization opt...
...artery bypasses with prosthetic graft material...
Surgical procedures should NOT be perform...
...Table 29. Revascular...
...s with CLI, revascularization should be...
...luation for revascularization options s...
...Table 30. E...
...ovascular procedures are recommended...
...approach to endovascular procedures is reason...
...sion characteristics can be useful in select...
...iosome-directed endovascular therapy may be reason...
...py for CLI: Findings That Prompt Consideration...
...Ta...
When surgery is performed for CLI, bypass to the...
...rocedures are recommended to establish i...
...patients with CLI for whom endovascular...
...staged approach to surgical procedur...
...Table 33...
...nterdisciplinary care team should ev...
...with CLI, wound care after revascu...
...patients with CLI, intermittent pneumatic compres...
...with CLI, the effectiveness of hyper...
...are NOT indicated in patients with CLI....
...Table...
...atients with ALI should be emergently evalua...
...ients with suspected ALI, initial cl...
...ALI, systemic anticoagulation with hepar...
...Ta...
...patients with ALI, the revasculariz...
...er-based thrombolysis is effective for patien...
...ion should be performed as the first proce...
...ts with ALI should be monitored and treated...
...ents with ALI with a salvageable l...
...nts with ALI due to embolism and wit...
...lness of ultrasound-accelerated catheter-based thr...
...Table 37. D...
...atient with ALI, a comprehensive history s...
...he patient with a history of ALI, tes...
...e 3. Diagnosis and Management o...
...Table 38. Longitud...
...PAD should be followed up with periodic clinical...
...PAD who have undergone lower extremity revascu...
...rasound can be beneficial for routine surve...
...ultrasound is reasonable for routine surve...
...ffectiveness of duplex ultrasound for routine...