SHM's Clinical Quick Talks-Peripheral Arterial Disease (PAD)

Pdf Summary

Peripheral Arterial Disease (PAD) is characterized by the narrowing or blockage of arteries in the lower extremities due to atherosclerosis. It affects up to 20% of individuals aged 50 or older and is more prevalent in men, although women experience greater disability. Risk factors include older age, smoking, diabetes, hypertension, and hyperlipidemia. PAD heightens the risk of myocardial infarction, stroke, and vascular-related mortality, and is often accompanied by atrial fibrillation.<br /><br />The condition leads to reduced blood flow, causing symptoms like pain during exercise (intermittent claudication), leg pain, coolness in limbs, poor wound healing, and more severe cases lead to critical limb ischemia with rest pain, gangrene, or ulcers. Only 20% of patients have claudication symptoms, while others remain asymptomatic.<br /><br />Diagnosis is primarily done using the Ankle-Brachial Index (ABI), with values less than 0.9 indicating PAD. Screening is advised for high-risk groups, particularly those over 50, with histories of smoking or diabetes. Various measurement techniques, including the Doppler method, are utilized. Both very low and high ABI readings are linked to increased cardiovascular risks and mortality.<br /><br />Management focuses on lifestyle modifications (cessation of smoking, exercise, diet, and weight management) and pharmacological interventions such as antiplatelet therapy, phosphodiesterase inhibitors, lipid-lowering agents, antihypertensive and antidiabetic medications. For severe cases, revascularization—either endovascular or surgical—may be necessary.<br /><br />It is essential to manage cardiovascular risks aggressively, given the association between low ABI scores and heightened risk of major cardiovascular and limb events. Medicare covers supervised exercise therapy for PAD as it enhances cardiovascular function and quality of life. Clopidogrel is preferred over aspirin in some scenarios for reducing cardiovascular events, especially where tolerance or cost are concerns.

Asset Subtitle

George Wuni, Dorrie-Susan Barrington

Keywords

Peripheral Arterial Disease

atherosclerosis

intermittent claudication

Ankle-Brachial Index

revascularization

cardiovascular risk

antiplatelet therapy

smoking cessation

Doppler method

Clopidogrel