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
...agnosis
...tion of PAD Key TermsHaving trouble viewi...
...ients at Increased Risk of PADHaving...
...e 3. History and/or Physical Examination Finding...
...story and Physical Examination...
Patients at increased risk of PAD (Table 2) sho...
...atients at increased risk of PAD (Table 2...
...ients with PAD should undergo noninvasive blo...
.... Resting ABI for Diagnosin...
...nts with history or physical examination f...
...BI results should be reported as abnormal (ABI...
...ients at increased risk of PAD (Table...
...ients not at increased risk of PAD (Table...
...6. Physiological Testing...
...I should be measured to diagnose patients...
...xertional non–joint-related leg symp...
...ents with PAD and an abnormal restin...
...h normal (1.00–1.40) or borderline (0.91–0.9...
...th PAD with an abnormal ABI (≤0.9...
...ative Diagnoses for Leg Pain or Claudication Wi...
...e 8. Alternative Diagnoses for Non-heali...
...re 1. Diagnostic Testing for Suspected...
...Diagnostic Testing for Suspected CLI...
...aging for Anatomic Assessment...
...ex ultrasound, computed tomography angiography (CT...
...ive angiography is useful for patien...
Invasive angiography is reasonable...
...asive and noninvasive angiography (i.e., CTA, MR...
.... Abdominal Aortic Aneurysm...
...ng duplex ultrasound for AAA is reasonable in pati...
Treatment
...eatment
.... Antiplatelet Agents...
...therapy with aspirin alone (range...
...asymptomatic patients with PAD (AB...
...matic patients with borderline ABI (0.91–0.9...
...effectiveness of dual-antiplatele...
...irin and clopidogrel) may be reasonable to redu...
...he overall clinical benefit of vorapaxar...
...ble 12. Statin Agents
...t with a statin medication is indicated for al...
Table 13. Antihypertensive...
...tihypertensive therapy should be administered...
...tensin-converting enzyme inhibitors or angiot...
...4. Smoking Cessation...
...tients with PAD who smoke cigarettes or use...
...with PAD who smoke cigarettes sho...
...th PAD should avoid exposure to environmental...
Table 15. Glycemic Control
...t of diabetes mellitus in the patient with PAD...
...ntrol can be beneficial for patients...
...able 16. Oral Anticoagulati...
...of anticoagulation to improve patency after...
...oagulation should NOT be used to reduce the ris...
...e 17. Recommendation for Cilostazol...
...lostazol is an effective therapy to impr...
...mmendation for Pentoxifylline
...oxifylline is not effective for trea...
Table 19. Recommendation for Chelation Therapy
Chelation therapy (e.g., ethylenediaminet...
...ble 20. Recommendation for Homocysteine Lowering...
B-complex vitamin supplementation to lower...
...Recommendation for Influenza Vaccinatio...
Patients with PAD should have an annual influenza...
...Structured Exercise Therapy...
...s with claudication, a supervised exercise program...
...rvised exercise program should be discussed as...
...patients with PAD, a structured community- or ho...
...patients with claudication, alternative strate...
...tructured Exercise Programs for PAD: D...
...24. Minimizing Tissue Loss in Patients...
...atients with PAD and diabetes mellitus should be...
...ts with PAD, prompt diagnosis and treatment of...
...atients with PAD and signs of foot inf...
...e to counsel patients with PAD without diab...
...l foot examination by a clinician i...
...disciplinary Care Team for PADHaving trouble vie...
...e 26. Recommendation for Revascularizat...
...scularization is a reasonable treatment option f...
...Endovascular Revascularization for Claudication...
...ovascular procedures are effective as a re...
...ovascular procedures are reasonable as a r...
...ss of endovascular procedures as a revasc...
...ndovascular procedures should NOT be per...
...urgical Revascularization for Claudication...
...cal revascularization is performed...
...urgical procedures are reasonable as a...
...ial artery bypasses with prosthetic graft...
...procedures should NOT be performed in patie...
...29. Revascularization for...
...th CLI, revascularization should be perform...
...ion for revascularization options...
...30. Endovascular Revascularization for CLI...
Endovascular procedures are recommende...
...aged approach to endovascular proced...
Evaluation of lesion characteristics can be use...
...ome-directed endovascular therapy may be rea...
...le 31. Therapy for CLI: Findings That Prompt Cons...
...32. Surgical Revascularization for CLI...
When surgery is performed for CLI, bypass...
...l procedures are recommended to establish in-line...
...ients with CLI for whom endovascular revas...
...aged approach to surgical procedures...
...Wound Healing Therapies for CLI...
...n interdisciplinary care team should eva...
...ts with CLI, wound care after revascul...
...with CLI, intermittent pneumatic compressio...
...nts with CLI, the effectiveness of hyperbaric...
...are NOT indicated in patients with CLI. (III - N...
...inical Presentation of ALI...
Patients with ALI should be emergently evalu...
...atients with suspected ALI, initial clinica...
...ALI Medical Therapy...
...n patients with ALI, systemic anticoagulation with...
.... Revascularization for ALI...
...ALI, the revascularization strate...
...ased thrombolysis is effective for pa...
...d be performed as the first procedure in...
...with ALI should be monitored and tr...
...th ALI with a salvageable limb, percutaneou...
...atients with ALI due to embolism and with a salvag...
...ness of ultrasound-accelerated catheter-based th...
Table 37. Diagnostic Evaluation of the Cause of...
...ient with ALI, a comprehensive history should...
...nt with a history of ALI, testing for a cardiovasc...
...gure 3. Diagnosis and Management of ALI...
...le 38. Longitudinal Follow-Up...
...tients with PAD should be followed up with peri...
...ith PAD who have undergone lower extrem...
...plex ultrasound can be beneficial for routine surv...
...d is reasonable for routine surveillance after e...
...ness of duplex ultrasound for routine surveilla...