Management of Peripheral Arterial Disease - American Family Physician

tive strategies,2 including intensive treatment for hyperlipidemia, hypertension, and smoking cessation. [Evidence level C, descriptive study] A lthough peripheral arterial disease (PAD) affects approximately 12 million persons in the United States, a recent study1 concluded that many physicians routinely do not obtain a relevant history for PAD and frequently overlook subtle signs of the condition on physical examination (Tables 1 and 2). The underdiagnosis of PAD in primary care Peripheral arterial disease is common, but the diagnosis frequently is overlooked because of subtle physical findings and lack of classic symptoms. Screening based on the ankle brachial index using Doppler ultrasonography may be more useful than physical examination alone. Noninvasive modalities to locate lesions include magnetic resonance angiography, duplex scanning, and hemodynamic localization. Major risk factors for peripheral arterial disease are cigarette smoking, diabetes mellitus, older age (older than 40 years), hypertension, hyperlipidemia, and hyperhomocystinemia. Nonsurgical therapy for intermittent claudication involves risk-factor modification, exercise, and pharmacologic therapy. Based on available evidence, a supervised exercise program is the most effective treatment. All patients with peripheral arterial disease should undergo aggressive control of blood pressure, sugar intake, and lipid levels. All available strategies to help patients quit smoking, such as counseling and nicotine replacement, should be used. Effective drug therapies for peripheral arterial disease include aspirin (with or without dipyridamole), clopidogrel, cilostazol, and pentoxifylline. (Am Fam Physician 2004;69:525-32,533. Copyright© 2004 American Academy of Family Physicians.) Management of Peripheral Arterial Disease