Peripheral arterial disease: Diagnosis and treatment

Abstract

The classic symptom of peripheral arterial disease (PAD) is intermittent claudication (IC); however, the ankle-brachial index, which is the Doppler ultrasound-recorded ratio of the systolic blood pressure in the ankle to that in the arm, is a much more sensitive method of diagnosis than subjective reports of IC. Among the major risk factors for PAD are advanced age, smoking, diabetes mellitus, hyperlipidemia, and hypertension. Based on its association with cardiovascular risk, PAD is now recognized as a coronary disease equivalent. Patients with PAD should therefore be managed with aggressive risk factor modification. A supervised aerobic exercise program based on walking or other forms of exercise involving the repetitive use of the major leg muscles should be recommended as an initial treatment for patients with IC. Revascularization should be considered in patients with rest pain, tissue loss, or significant lifestyle limitations.