Peripheral Arterial Disease: Medical Care and Prevention of Complications

David L. Dawson, MD; William R. Hiatt, MD; Mark A. Creager, MD; Alan T. Hirsch, MD


Prev Cardiol. 2002;5(3) 

In This Article

Abstract and Introduction

Peripheral arterial disease (PAD) is a common but under-recognized problem affecting older patients. Intermittent claudication is the most frequent symptom of PAD, although the diagnosis of PAD is often overlooked until the patient presents with limb-threatening ischemia. Importantly, PAD is a marker for generalized atherosclerosis and is closely associated with coronary and cerebrovascular disease. The severity of PAD has been correlated with an increased risk of myocardial infarction, stroke, and cardiovascular death. The recognition and diagnosis of PAD, combined with its appropriate medical management, may well reduce the overall risk of cardiovascular morbidity. When diagnosed early, both exercise and pharmacotherapy can ameliorate symptoms of claudication, augment functional performance, and improve quality of life.

Peripheral arterial disease (PAD) is commonly encountered in general practice. PAD should be recognized as an important marker for cardiovascular disease, but specific therapy directed to the management of PAD manifestations is indicated for most patients.

There is a need for a standardized, evidence-based management approach to PAD. This need provided the impetus for the development and recent publication of consensus recommendations for most aspects of PAD care.[1] These recommendations were developed through a 3-year process of collaboration between North American and European vascular professional societies, in the fields of cardiology, vascular medicine, radiology, and surgery. The product of this long, collaborative process, the TransAtlantic Inter-Society Consensus, also identified many unresolved critical issues, including the uncertain benefits and cost effectiveness of many widely used diagnostic and therapeutic modalities.

This paper provides a review for physicians who care for patients with known or occult PAD, focusing on the epidemiology, office-based diagnostic evaluation, general medical management, and specific therapeutic options for patients with intermittent claudication. Because PAD is a manifestation of generalized atherosclerosis, the principal issue in medical management of PAD is the development of a treatment plan that modifies known risk factors for atherosclerosis and its atherothrombotic complications. It is also recognized that selected patients with disabling claudication symptoms may benefit from surgical therapy or catheter-based interventions, but most PAD patients do not require revascularization procedures. In contrast, this review focuses on global PAD management approaches that are needed for quality long-term PAD care, as offered by the primary care clinician/family physician, general internist, adult nurse practitioner, physician's assistant, or cardiologist.