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  • image The prevalence of peripheral arterial disease is dependent on age and the presence of traditional risk factors for cardiovascular disease and many patients are undiagnosed; undiagnosed patients have substantial risk for coronary and cerebrovascular events.
  • image The clinical presentation of peripheral arterial disease is variable and includes a range of symptoms. The two most common characteristics of peripheral arterial disease are intermittent claudication 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 peripheral arterial disease.
  • 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 peripheral arterial disease.
  • image Data proving that antiplatelet therapies can prevent or delay the progression of peripheral arterial disease 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 have been implemented, patients who continue to experience severe intermittent claudication may benefit from additional pharmacologic therapy with cilostazol.

On completion of the chapter, the reader will be able to:

  1. Compare and contrast the reported prevalence rates for peripheral arterial disease (PAD) using patient self-report, clinical assessment, and objective measures such as the ankle-brachial index (ABI).

  2. Describe how the diagnosis of PAD is made, considering history, physical findings, and clinical testing.

  3. Write goals of therapy in the management of PAD, including goals for blood flow, walking distance, and management of modifiable risk factors.

  4. Provide recommendations for smoking cessation and exercise for PAD patients, and outline when patients should be referred for surgical or catheter-based interventions.

  5. Describe goals of therapy for the management of the risk factors for PAD including hypertension, hyperlipidemia, and diabetes.

  6. Outline the rationale for antiplatelet therapy, and summarize the evidence for efficacy of aspirin, aspirin plus dipyridamole, clopidogrel, and ticlopidine in modifying vascular end points in PAD patients.

  7. Describe the potential role for cilostazol and pentoxifylline in the management of intermittent claudication.

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 prior 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 ...

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