Masterclass series in peripheral arterial disease

Abstract

Peripheral arterial disease (PAD) of the lower extremities is a common and potentially life-threatening manifestation of systemic atherosclerosis. Significant PAD is identified by an ankle brachial index (ABI) Ͻ0.90; its presence is strongly associated with the major modifiable cardiac risk factors. Early detection and treatment of asymptomatic PAD is a current focus of numerous cardiovascular guideline organizations as less than a third of patients report typical claudication symptoms. This has created an ever-increasing treatment gap, whereby millions of eligible patients are inadequately treated. Risk factor management including exercise, smoking cessation, and aggressive treatment of lipids and blood pressure are essential in PAD patients. However, life-long antiplatelet therapy provides additional reductions in vascular events beyond aggressive risk factor management. The use of aspirin as well as more potent antiplatelet therapies such as thienopyridines holds promise for reducing atherothrombosis in this very high-risk population.

Screening for Peripheral Arterial Disease and Carotid Artery Disease in Patients With Abdominal Aortic Aneurysm

“…1 There is a close relationship between coronary artery disease and CAD, and PAD is associated with an increased cardiovascular (CV) risk and death. [2][3][4][5][6] Patients with abdominal aortic aneurysms (AAAs) commonly have CV disease, yet there is little in the literature to assess whether screening these patients for other vascular disorders is worthwhile. 7 The accuracy of color duplex ultrasound (CDU) is high, but mass screening is not cost effective.…”

Biomarkers of Peripheral Arterial Disease

“…However, of much greater concern is the very real cost to the health care system and to the patient, of not identifying individuals with PAD. The primary purpose in screening for PAD is to identify individuals at high risk of vascular events(25) (9) (8) (26,27) so as to target them for aggressive risk reduction interventions (28) (29) (30) (31), (32) (33). Unfortunately, most PAD patients are currently not diagnosed, and not receiving therapies that can improve their prognosis (13) (34).…”