Peripheral arterial disease: Evaluation, risk factor modification, and medical management

Objective: To review the evaluation and medical management of peripheral arterial disease (PAD). Methods: Review of the literature. Results: PAD is a highly prevalent but underrecognized and undertreated condition associated with significant morbidity and mortality. PAD is an important manifestation of systemic atherosclerosis, which reduces arterial blood to the lower extremities during exercise or rest. It has a strong association with the well-defined atherosclerotic risks factors such as diabetes mellitus, cigarette smoking, advanced age, hyperlipidemia, and hypertension and can have a varied clinical presentation. PAD can be diagnosed accurately with a comprehensive history and physical examination and simple, noninvasive, tests. Given the association of PAD with significant morbidity and mortality and multiple atherosclerotic risk factors, aggressive risk factor modification and secondary prevention strategies such as antiplatelet therapy, lipid lowering therapy, smoking cessation, diabetes control, and anti-hypertensive treatment should be considered in patients with PAD. Therapeutic angiogenesis using gene-based growth factors and stem cell-based therapies remain a promising future option for the treatment of PAD. Conclusion: Clinicians should have a high index of suspicion for PAD in patients with atherosclerotic risk factors. These patients will benefit from early detection of PAD and aggressive management.