What are the SVS diagnostic guidelines for peripheral arterial occlusive disease (PAOD)?

Updated: Sep 12, 2019
  • Author: Josefina A Dominguez, MD; Chief Editor: Vincent Lopez Rowe, MD  more...
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Answer

In 2015, the Society for Vascular Surgery (SVS) issued practice guidelines for management of atherosclerotic disease of the lower extremities. [14]

Recommendations for diagnosis of peripheral arterial disease (PAD) include the following:

  • Ankle-brachial index (ABI) is recommended as the first-line noninvasive test to establish a diagnosis of PAD in individuals with symptoms or signs suggestive of disease. If the ABI is borderline or normal (>0.9) and symptoms of claudication are suggestive, an exercise ABI is recommended (grade 1 recommendation; evidence level A).
  • Routine screening is not suggested for lower-extremity PAD in the absence of risk factors, history, signs, or symptoms of PAD (grade 2 recommendation; evidence level C).
  • For asymptomatic individuals at elevated risk (eg, those aged >70 years, smokers, diabetic patients, those with an abnormal pulse examination, and those with other established cardiovascular disease), screening for lower-extremity PAD is reasonable if used to improve risk stratification, preventive care, and medical management (grade 2 recommendation; evidence level C).
  • In symptomatic patients being considered for revascularization, physiologic noninvasive studies (eg, segmental pressures and pulse volume recordings) are suggested to aid in quantification of arterial insufficiency and help localize the level of obstruction (grade 2 recommendation; evidence level C).
  • In symptomatic patients being considered for revascularization treatment, anatomic imaging studies (eg, arterial duplex ultrasonography [DUS], computed tomography [CT] angiography [CTA], magnetic resonance angiography [MRA], and contrast arteriography) are recommended (grade 1 recommendation; evidence level B).

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