Peripheral Artery Disease Lower Extremity

Publication Date: November 13, 2016

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

...Diagnosis...

...tion of PAD Key Terms...


...2. Patients at Increased Risk of PAD...


...3. History and/or Physical Examination Finding...


...Table 4....

...eased risk of PAD (Table 2) should un...

Patients at increased risk of PAD (Table 2) s...

...th PAD should undergo noninvasive blood pre...


...Table 5. Resting ABI...

...patients with history or physical examination...

...BI results should be reported as abnorma...

...patients at increased risk of PAD (...

...ents not at increased risk of PAD...


...Table 6....

TBI should be measured to diagnose patients wit...

Patients with exertional non–joint-related...

...ients with PAD and an abnormal resti...

...s with normal (1.00–1.40) or borderlin...

...th PAD with an abnormal ABI (≤0.9...


...Alternative Diagnoses for Leg Pain or Clau...


...rnative Diagnoses for Non-healing Wounds With No...


...gure 1. Diagnostic Testing for Suspected...


...e 2. Diagnostic Testing for Suspe...


...Table 9. Imaging f...

Duplex ultrasound, computed tomography...

...graphy is useful for patients with CLI in...

...asive angiography is reasonable for pa...

...and noninvasive angiography (i.e., CTA, MRA)...


...Table 10. Abdomina...

...ng duplex ultrasound for AAA is rea...


Treatment

...Treat...

...Table 11. Antiplatel...

...latelet therapy with aspirin alone (range 75...

...atic patients with PAD (ABI ≤0.90), antiplat...

...n asymptomatic patients with borderline ABI (0....

...e effectiveness of dual-antiplatelet th...

...T (aspirin and clopidogrel) may be reasonable to...

...clinical benefit of vorapaxar added to existin...


...Table...

...th a statin medication is indicated for...


...Table 13. An...

Antihypertensive therapy should be...

...of angiotensin-converting enzyme i...


...th PAD who smoke cigarettes or use other fo...

...th PAD who smoke cigarettes should be assiste...

...h PAD should avoid exposure to environmental...


...Ta...

...abetes mellitus in the patient with...

...can be beneficial for patients with CLI to...


...Table 16....

...he usefulness of anticoagulation to improve patenc...

...coagulation should NOT be used to red...


...Table 17. Rec...

...lostazol is an effective therapy to i...


...Table 18. Reco...

...fylline is not effective for treatment of...


...Table 19. Recomm...

...py (e.g., ethylenediaminetetraacetic acid...


...Table 20....

...omplex vitamin supplementation to lower homocyst...


...Table 21. R...

Patients with PAD should have an annual...


...Table 22....

...n patients with claudication, a supe...

...vised exercise program should be discu...

...PAD, a structured community- or home-based exerci...

...ith claudication, alternative strategies of...


...3. Structured Exercise Programs for PAD:...


...Table 24. Minimizing Tissue...

...s with PAD and diabetes mellitus sh...

...with PAD, prompt diagnosis and tre...

...h PAD and signs of foot infection, p...

...e to counsel patients with PAD without di...

...al foot examination by a clinician is reasonable...


...ble 25. Interdisciplinary Care Team fo...


...Table 26. Reco...

...ascularization is a reasonable treatment option fo...


...Table 2...

...ovascular procedures are effective as a rev...

...cular procedures are reasonable as a rev...

...ess of endovascular procedures as a revas...

Endovascular procedures should NOT be pe...


...revascularization is performed, bypass to the pop...

...res are reasonable as a revascularization opt...

...artery bypasses with prosthetic g...

...al procedures should NOT be performed in pati...


...Table 29....

...ith CLI, revascularization should be performe...

...valuation for revascularization options should be...


...Table 30...

...lar procedures are recommended to establis...

A staged approach to endovascular procedures is re...

...uation of lesion characteristics can be usefu...

...angiosome-directed endovascular therapy m...


...rapy for CLI: Findings That Prompt Cons...


...Table 32....

...urgery is performed for CLI, bypass to the...

...ocedures are recommended to establish in-line bl...

...patients with CLI for whom endovascular revas...

...ch to surgical procedures is reasonabl...


...Table 33. Wound Healin...

...iplinary care team should evaluate...

...ents with CLI, wound care after revascul...

...ith CLI, intermittent pneumatic compression...

...ients with CLI, the effectiveness of...

...noids are NOT indicated in patients with CLI....


...Table 34. Cli...

...ents with ALI should be emergently evaluate...

In patients with suspected ALI, initial clinical e...


...Table 35....

...ALI, systemic anticoagulation with heparin shou...


...Table 36. Revasculariz...

...ients with ALI, the revascularization strat...

...-based thrombolysis is effective for patients w...

...putation should be performed as th...

...tients with ALI should be monitored and treated...

...with ALI with a salvageable limb, percutaneous mec...

...ALI due to embolism and with a salvageable limb...

...of ultrasound-accelerated catheter-based throm...


...Table 37. Diagnosti...

...the patient with ALI, a comprehensive hist...

...n the patient with a history of ALI, te...


...ure 3. Diagnosis and Management of...


...Table 38. Longitu...

...ith PAD should be followed up with periodic clini...

...h PAD who have undergone lower extremity re...

Duplex ultrasound can be beneficial for routine...

Duplex ultrasound is reasonable for routine...

...ffectiveness of duplex ultrasound for routin...