Clinical significance, detection, and medical treatment for peripheral arterial disease

Peripheral Arterial Disease: A Review of Disease Awareness and Management

BACKGROUND

Peripheral arterial disease (PAD) is a progressive atherosclerotic condition affecting approximately 27 million people in North America and Europe. Albeit a common clinical malady, it is underrecognized and undertreated.

OBJECTIVE

The goal of this article was to review the pathophysiology, clinical implications, diagnosis, and management of PAD.

METHODS

Relevant published information was identified through a search of MEDLINE (1966-2006). Search terms used included peripheral vascular diseases, intermittent claudication, arterial occlusive diseases, antiplatelet therapy, HMG-CoA reductase inhibitors, risk factors, smoking cessation, adrenergic beta-antagonists, and angiotensin-converting enzymes.

RESULTS

PAD is associated with an increased risk of cardiovascular and cerebrovascular disease as well as a reduction in quality of life. PAD symptoms are not always present with the disease; therefore, improvements in screening methods for at-risk patients are necessary. Patients at risk for PAD should be routinely screened, and appropriate management--including antiplatelet therapy and risk factor modifications--should be initiated once the disease is recognized. Risk factor modifications should include smoking cessation as well as blood pressure and cholesterol management. Acetylsalicylic acid (ASA) is the antiplatelet of choice, and clopidogrel should be used as an alternative if ASA therapy is contraindicated or an intolerance is present. Cilostazol has a minimal role for the symptomatic relief in patients with disabling intermittent claudication. All patients with PAD should be treated with a 3-hydroxy-3-methylglutaryl coenzyme A reductase inhibitor and potentially an angiotensin-converting enzyme inhibitor. Beta-Blockers should not be avoided unless documented worsening of symptoms is associated with their use.

CONCLUSIONS

Patients at risk for PAD should be routinely screened, and appropriate management including antiplatelet therapy and risk factor modifications should be initiated once the disease is recognized.

Pharmacist Detection of Peripheral Arterial Disease Through the Use of a Handheld Doppler

STUDY OBJECTIVE

To evaluate the effectiveness of a program in which pharmacists screened at-risk patients for peripheral arterial disease using a handheld doppler device.

DESIGN

Prospective study.

SETTING

Primary care and consultative outpatient clinic.

PATIENTS

Forty-one physician-referred patients older than 55 years who had no documented history of peripheral arterial disease.

INTERVENTION

The pharmacists administered the San Diego Claudication Questionnaire and performed doppler examinations to calculate ankle-to-brachial indexes (ABIs). Patients with symptoms of claudication or with an ABI of 0.9 or less were considered to have possible peripheral arterial disease. Each diagnosis was confirmed by a physician. These patients were either referred for further evaluation, provided with immediate treatment, or told to continue their current drug regimen, if appropriate.

MEASUREMENTS AND MAIN RESULTS

Eight (19.5%) of the 41 patients were diagnosed with peripheral arterial disease. Antiplatelet therapy was started in five patients, and one patient was referred to a vascular specialist.

CONCLUSION

This pharmacist-initiated program effectively detected peripheral arterial disease in previously unscreened patients.