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  • image The prevalence of peripheral arterial disease (PAD) is dependent on age and the presence of traditional risk factors for cardiovascular disease (CVD) and many patients are undiagnosed; undiagnosed patients have substantial risk for coronary and cerebrovascular events.

  • image The clinical presentation of PAD is variable and includes a range of symptoms. The two most common characteristics of PAD are intermittent claudication (IC) and pain at rest in the lower extremities.

  • image The ankle-brachial index (ABI) is a simple, noninvasive, quantitative test that has been proven to be a highly sensitive and specific tool in the diagnosis of PAD.

  • image As with any atherosclerotic condition, several risk factors play an important role in the morbidity and mortality of peripheral vascular disease. Many of these risk factors are modifiable with the help of various nonpharmacologic and pharmacologic interventions.

  • image Nonpharmacologic interventions such as smoking cessation and walking exercise programs have the ability to positively impact several of the pathophysiologic abnormalities present in patients with PAD.1

  • image Data proving that antiplatelet therapies can prevent or delay the progression of PAD are currently unavailable. However, aspirin therapy has repeatedly been proven to significantly reduce serious vascular events in these “high-risk” patients and, in the absence of contraindications, is highly recommended.

  • image After appropriate exercise therapy and therapeutic lifestyle changes (TLC) have been implemented, patients who continue to experience severe IC may benefit from additional pharmacologic therapy with cilostazol.

Peripheral arterial disease (PAD), the most common form of peripheral vascular disease, is a manifestation of progressive narrowing of arteries due to atherosclerosis.1 PAD is associated with elevated risk of cardiovascular disease (CVD) morbidity and mortality, even in the absence of history of acute myocardial infarction (AMI), stroke, or other manifestations of CVD.2 Patients with PAD have approximately the same relative risk of death from CVD as do patients with a history of coronary or cerebrovascular disease, and PAD should be considered a surrogate marker of subclinical coronary artery disease (CAD) and other vascular territories. The treatment of PAD focuses on decreasing the functional impairment caused by symptoms of intermittent claudication (IC) through nonpharmacologic and pharmacologic therapy and by minimizing the impact of other cardiovascular risk factors.3


image PAD affects approximately 8.5 million with an estimated prevalence of 2.76% of adults aged 40 years and older in the United States.1 The prevalence of PAD is highly dependent on age, being infrequent in younger individuals and common in older individuals (Fig. e22-1). In age- and gender-adjusted logistic regression analyses, black race/ethnicity (odds ratio [OR] 2.83), current smoking (OR 4.46), diabetes (OR 2.71), hypertension (HTN; OR 1.75), hypercholesterolemia (OR 1.68), and impaired renal function (estimated glomerular filtration rate less than 60 mL/min/1.73 m2) (OR 2) were associated with more prevalent PAD.4 Individuals with PAD are also more likely to have a self-reported history of any CAD or CVD but, interestingly, no ...

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