Applied Evidence

How to refine your approach to peripheral arterial disease

Author and Disclosure Information

 

References

Diagnostic testing

An ankle-brachial index (ABI) test should be performed in patients with history or physical exam findings suggestive of PAD. A resting ABI is performed with the patient in the supine position, with measurement of systolic blood pressure in both arms and ankles using a Doppler ultrasound device. Table 213 outlines ABI scoring and interpretation.

Interpretation of the ankle-brachial index

An ABI > 1.4 is an invalid measurement, indicating that the arteries are too calcified to be compressed. These highly elevated ABI measurements are common in patients with diabetes and/or advanced CKD. In these patients, a toe-brachial index (TBI) test should be performed, because the digital arteries are almost always compressible.13

Patients with symptomatic PAD who are under consideration for revascularization may benefit from radiologic imaging of the lower extremities with duplex ultrasound, computed tomography angiography, or magnetic resonance angiography to determine the anatomic location and severity of stenosis.13

Management of PAD

Lifestyle interventions

For patients with PAD, lifestyle modifications are an essential—but challenging—component of disease management.

Continue to: Smoking cessation...

Pages

Recommended Reading

New AHA scientific statement on menopause and CVD risk
MDedge Family Medicine
Colchicine a case study for what’s wrong with U.S. drug pricing
MDedge Family Medicine
Infant’s COVID-19–related myocardial injury reversed
MDedge Family Medicine
COVID-19 fuels surge in overdose-related cardiac arrests
MDedge Family Medicine
COVID-19 and risk of clotting: ‘Be proactive about prevention’
MDedge Family Medicine
Calcium burden drives CV risk whether coronary disease is obstructive or not
MDedge Family Medicine
Fracking sites tied to increased heart failure hospitalizations
MDedge Family Medicine
Home visits: A practical approach
MDedge Family Medicine
How to identify and treat common bites and stings
MDedge Family Medicine
Consider this Rx for patients with high triglycerides?
MDedge Family Medicine