Referring Physicians >> Newsletters >> Essential Practices for Diagnosing and Treating Lower Extremity PAD
Essential Practices for Diagnosing and Treating Lower Extremity PAD
Lower extremity peripheral artery disease (PAD) can lead to significant functional impairment and predict future cardiovascular events. Learn how the ankle/brachial index (ABI) can be used for diagnosing PAD, common interventions for PAD, and when to refer to a vascular surgeon.
ABI <0.9 Positively Predicts PAD
Major risk factors for PAD include age over 70, smoking, hyperlipidemia, hypertension, diabetes mellitus, or atherosclerosis.
PAD is frequently undetected in the clinic setting. Only about a third of patients with PAD have classic claudication symptoms: intermittent exertional calf pain that resolves with rest. Skin temperature, peripheral pulses, or bruits are poor predictors of PAD in asymptomatic patients. Many other conditions cause leg pain and can be confused with PAD.
For at-risk patients, a low (<0.9) ankle-brachial index (ABI) positively predicts PAD more accurately than history and physical examination alone.
Lower-extremity angiography is only recommended for patients with advanced disease who are being considered for surgical intervention.
Start with Smoking Cessation, Walking Programs—and Monitor Closely
For patients diagnosed with PAD, smoking cessation and walking programs can improve symptoms, slow disease progression, and delay functional impairment.
Key options for medical therapy include aspirin, blood pressure control, and statins. Cilostazol can be used for patients with claudication. These interventions can reduce symptoms and retard the progression of PAD.
Patients with minimal to moderate functional impairment should be followed at least once per year to monitor for leg, coronary, or cerebrovascular ischemia.
Refer to a Surgeon if Ischemia, Stenosis Suspected
Patients with symptoms of critical limb ischemia (CLI)—chronic lower extremity pain at rest, ulcers, or gangrene—should be referred to a vascular surgery team for further assessment. Those patients may require endovascular or surgical revascularization to preserve the limb.
In addition, patients with PAD who have lifestyle-limiting symptoms and clinical concern for PAD should also be referred for further physiologic testing, imaging studies and maximum medical therapy trials. A minority of these patients may benefit from endovascular (catheter based) or surgical treatment.
At UW Health, patients referred to the vascular surgery team can usually be seen within a week. Patients with critical problems can be seen with 24 hours.
Though rare, acute limb ischemia (ALI)—marked by sudden limb pain, pulselessness, pallor, paresthesias, and paralysis—is an emergency. Patients with ALI should be sent to the emergency department as soon as possible to determine limb viability and, if appropriate, undergo immediate revascularization.
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For More Information
For more information about PAD diagnosis and treatment, or to contact our vascular surgery team, please click here.
View the complete Clinical Practice Guidelines from the Society for Vascular Surgery (SVS) here.
View the complete Vascular Patient Resources – with free downloadable educational resources and patient materials – from the Society for Vascular Surgery (SVS) here.