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KEY CONCEPTS

KEY CONCEPTS

  • image Peripheral arterial disease (PAD) is a form of atherosclerotic cardiovascular disease (ASCVD) that occurs in the peripheral arteries. Lower extremity PAD is the most common form of PAD.

  • image Lower extremity PAD is associated with an increased risk of limb loss and death.

  • image The most prevalent PAD risk factors are tobacco smoking, diabetes mellitus (DM), hypertension, and dyslipidemia. The risk of developing PAD increases with age.

  • image Symptoms of lower extremity PAD may include cramping or discomfort in the affected lower extremity(ies). A significant portion of those with PAD will be asymptomatic. Signs of lower extremity PAD include, but are not limited to, diminished or absent pedal pulses, nonhealing wounds, brittle and hypertrophic toenails, and/or cool skin. The presence of signs and/or symptoms in those at risk for PAD should prompt further evaluation.

  • image The ankle-brachial index (ABI) is the most common test used to diagnose lower extremity PAD. PAD is defined by an ABI score ≤0.9 for one or more of the pedal pulses (ie, dorsalis pedis, posterior tibial). A score >1.4 is indicative of noncompressible arteries which may be present in those with DM and/or chronic kidney disease (CKD).

  • image ASCVD risk reduction is prudent to lower the risk of cardiovascular (CV) complications associated with PAD. This includes acheiving good glycemic and blood pressure (BP) control. A high-intensity statin is recommended to reduce the risk of CV and limb-related events. Smoking cessation has been shown to reduce the risk of limb loss and death.

  • image Participation in a structured exercise training program has been shown to improve functional status and quality of life and to decrease lower extremity symptoms.

  • image Revascularization surgery is a potential therapeutic option for patients who have persistent lower extremity PAD symptoms despite pharmacological therapy, exercise, and smoking cessation.

  • image Low-dose aspirin or clopidogrel is recommended for patients with symptomatic lower extremity PAD to lower the risk of CV events and death.

  • image An antithrombotic regimen should be prescribed after revascularization surgery to lower the risk of CV events and limb-related events. Options include aspirin or clopidogrel monotherapy, dual antiplatelet therapy with aspirin and clopidogrel, or rivaroxaban 2.5 mg twice daily combined with low-dose aspirin.

  • image Cilostazol can be considered in those with lower extremity PAD symptoms despite other pharmacological therapy, exercise, and smoking cessation. This agent is not to be used in those with heart failure due to an increased risk of death.

BEYOND THE BOOK

BEYOND THE BOOK

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INTRODUCTION

image Peripheral arterial disease (PAD) is characterized by atherosclerosis of the peripheral arteries. Lower extremity PAD specifically refers to atherosclerotic disease from the aortoiliac segments to the pedal arteries.1 While PAD can occur in several peripheral arteries, this chapter ...

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