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UPDATE SUMMARY

UPDATE SUMMARY

The following updates were made September 29, 2020:

  • Diabetes Mellitus section under Pharmacologic Therapy was updated to reflect new guidelines

  • Updated the Antiplatelet Drug Therapy section include:

    • Addition of clinical trial data that call into question the routine use of aspirin

    • Ticolopidine (Ticlid) section has been removed; the drug is no longer available in the United States

  • Renamed Non-Vitamin K Oral Anticoagulants section (now Direct Oral Anticoagulants) and updated to include data from the VOYAGER-PAD study

  • Cilostazol (Pletal) section updated to include patient education

KEY CONCEPTS

KEY CONCEPTS

  • imageThe prevalence of peripheral arterial disease (PAD) is related to age and the presence of atherosclerotic risk factors for cardiovascular disease (CVD).

  • imageDespite significant morbidity and mortality, PAD awareness remains low resulting in many undiagnosed and untreated patients.

  • imageThe 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.

  • imageThe ankle-brachial index (ABI) is a simple, noninvasive, quantitative test that is a highly sensitive and specific tool to diagnose PAD.

  • imageSeveral atherosclerotic risk factors play an important role in the development and progression of PAD. Many of these risk factors are modifiable using various nonpharmacologic and pharmacologic interventions.

  • imageNonpharmacologic interventions, such as a supervised exercise program, can improve a patient's quality of life and reduce leg symptoms.

  • imageAntithrombotic therapy is recommended in select patients with PAD to reduce the risk of myocardial infarction, stroke, and vascular death.

  • imageIn addition to exercise therapy and risk factor modification, cilostazol is an effective medication to reduce leg symptoms and increase walking distance in patients with IC.

PRECLASS ACTIVITY

Preclass Engaged Learning Activity

Watch a Patient Stories video from the nonprofit organization Vascular Cures’ website (http://vascularcures.org/video-library/). These 3-minute testimonial videos describe the symptoms and limitations patients experience due to peripheral arterial disease, and the interventions responsible for the improvement in their quality of life. The video is useful to enhance your understanding regarding the COLLECT and ASSESS steps in the patient care process.

Self-Guided Questions:

  1. 1. What are the typical and atypical symptoms reported by patients in these testimonial videos?

  2. 2. Based on the patient stories, how would you assess their symptoms using the Fontaine and Rutherford classification systems?

  3. 3. What types of pharmacological and nonpharmacological interventions did these patients receive for their PAD?

INTRODUCTION

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 an elevated risk of cardiovascular disease (CVD) morbidity and mortality, even in the absence of a history of acute myocardial infarction (AMI), stroke, or other manifestations of CVD.1,2 Patients with PAD have approximately the same relative risk of death from CVD as do ...

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