A review of simple, non-invasive means of assessing peripheral arterial disease and implications for medical management

Atherosclerotic peripheral arterial disease (PAD) is highly prevalent in the elderly and subjects with atherosclerotic risk factors such as smoking, diabetes mellitus, hypertension, and hyperlipidemia. Importantly, PAD is rarely an isolated condition, but rather a manifestation of systemic atherosclerosis. Hence, there is often coexisting disease in the coronary and cerebral arteries and, consequently, an increased risk of myocardial infarction and stroke. Intermittent claudication is the classic symptom of PAD, yet up to 50% of patients are asymptomatic. Despite the availability of reliable, non-invasive screening tests, PAD is largely underdiagnosed and undertreated, mostly due to the paucity of symptoms and underutilization of screening tools. The ankle-brachial index (ABI), a simple, rapid, and inexpensive diagnostic tool, holds much prognostic value for PAD diagnosis and is ideal for implementation in the primary care physician's office. The early detection of PAD with ABI screening and subsequent medical management represents a critical opportunity to prevent considerable vascular morbidity and mortality. The management of PAD must address claudication symptoms (with cilostazol or pentoxifylline, or in severe cases endovascular or surgical revascularization) and modifiable atherosclerotic risk factors (with an aggressive global risk-reduction regimen involving lifestyle modifications, exercise, smoking cessation, and antiplatelet, lipid-lowering, and antihypertensive therapy).