Guideline for Peripheral Arterial Disease

If you are wondering what the procedure and guidelines are for peripheral arterial disease, the National Guideline Clearinghouse of the U.S. Department of Health and Human Services has provided a thorough summary. Below is a brief excerpt from the guideline:

Diagnosis/Evaluation

1. Medical history and review of symptoms (ROS)
2. Diagnostic methods
   • Ankle-brachial index (ABI) and toe-brachial index
   • Segmental pressure examination
   • Pulse volume recoding
   • Continuous-wave Doppler ultrasound
   • Duplex ultrasound
   • Treadmill exercise testing with and without ankle-brachial index assessments and 6-minute walk test
   • Computed tomographic angiography (CTA)
   • Magnetic resonance angiography (MRA)
   • Contrast angiography

Management/Treatment/Prevention

1. Cardiovascular risk reduction
   • Lipid-lowering drugs (statins, fibric acid derivatives)
   • Antihypertensive drugs (beta-blockers, angiotensin-converting enzyme [ACE] inhibitors)
   • Diabetes management (foot inspection, skin cleansing, glucose control)
   • Smoking cessation (behavioral therapy, nicotine replacement therapy, bupropion)
   • Antiplatelet and antithrombotic drugs
   • Note: The following drugs were considered but not recommended: homocysteine-lowering drugs, such as folic acid, vitamin B₁₂
2. Treatment of claudication
   • Supervised exercise programs
   • Pharmacological treatment (cilostazol, pentoxifylline)
   • Note: The following agents were considered but not recommended: L-arginine, propionyl-L-carnitine, ginkgo biloba, oral prostaglandins, vitamin E, chelation
   • Endovascular treatment (e.g., stenting, lasers, atherectomy, percutaneous transluminal angioplasty [PTA], thermal angioplasty)
   • Surgery (inflow and outflow procedures)
3. Treatment for limb salvage (critical limb ischemia [CLI])
   • Parenteral prostaglandins (limited efficacy)
   • Angiogenic growth factors (considered but not recommended outside of clinical trials)
   • Endovascular treatment
   • Thrombolysis
   • Surgery
4. Prevention: vascular ROS and prompt use of the ABI test, comprehensive pulse examination, feet inspection, and review of family history of abdominal aortic aneurysm for patients at risk for lower extremity peripheral arterial disease

For the complete guideline, please visit the website.