Peripheral Arterial Disease

Peripheral arterial disease is common yet underdiagnosed particularly in the aging population. Even when asymptomatic, PAD is associated with progressive functional decline and represents a coronary artery disease equivalent for major cardiovascular events. Diagnostic evaluation includes a thorough pulse exam and noninvasive studies (e.g., ankle brachial index) to establish the presence and severity of arterial occlusive disease. Treatment for PAD is focused on risk factor modification with medical therapy for cardiovascular risk factors, smoking cessation, diet, and exercise with an emphasis on walking. Further imaging is only necessary when vascular intervention is being considered. Surgical or interventional treatment is guided by symptoms and is tailored to individual goals and preferences. Specific tools have been developed to help guide treatment decisions that take into account clinical presentation, revascularization efficacy, likelihood of amputation, and functional reserve.