Clinical significance, detection, and medical treatment for peripheral arterial disease

Denuded vascular endothelium, impaired microcirculation, arterial insufficiency, tissue ischemia, and organ damage define the pathophysiologic spectrum of PAD. In afflicted patients, these aberrations are the basis of a sharply increased risk of death due to cardiac events and stroke. Despite the potential breadth of structural and perfusion impairments, PAD often is asymptomatic or clinically unrecognized for a prolonged period until a catastrophic coronary, or a cerebral or limb-threatening event occurs. The existence of non-classic or atypical presentations of the coronary and cerebral vasculature is well established, and in customary clinical practice, vigilance remains high for such presentations. Atypical and non-classic presentations of PAD are also common, a fact that is evidently less well recognized. Clinicians should therefore familiarize themselves with the myriad manifestations of both symptomatic and asymptomatic PAD to reduce delay in diagnosis and improve access to specific therapies. Healthcare providers can screen for and diagnose PAD and IC in the office setting and initiate specific therapies. Whether it is cost-effective to screen individuals in a noninvasive vascular laboratory is undetermined. However, office-based screening during routine physical examination - by using simple questionnaires and measuring the ABI - is rapid and relatively easy and may identify patients with significantly advanced disease who are candidates for intensive risk-reduction interventions. Healthcare providers must become more aware of the high likelihood for PAD and IC in their elderly patients and encourage them to modify their risk factors for atherosclerotic disease.