This Article  • Full text  • PDF  • Send to a friend  • Save in My Folder  • Save to citation manager  • Permissions  Citing Articles  • Citation map  • Citing articles on HighWire  • Citing articles on ISI (34)  • Contact me when this article is cited  Related Content  • Similar articles in this journal  Topic Collections  • Cardiovascular Disease/ Myocardial Infarction  • Cardiac Diagnostic Tests  • Alert me on articles by topic

Identification and Implications

Emile R. Mohler III, MD

Arch Intern Med. 2003;163:2306-2314.

Peripheral arterial disease (PAD) is most commonly a manifestation of systemic atherosclerosis in which the arterial lumen of the lower extremities becomes progressively occluded by atherosclerotic plaque. Patients with PAD are at triple the risk of all-cause mortality and at more than 6 times the risk of death from coronary heart disease as those without the disease, yet PAD is probably the most underdiagnosed and least aggressively managed atherosclerotic disease. In the diagnosis of PAD, a detailed history and physical examination are extremely important, although limited by a lack of consistent sensitivity and specificity. Other office-based noninvasive tests, including the ankle-brachial index, can be easily performed to confirm the diagnosis and help stratify the risk. The ankle-brachial index correlates well with disease severity and functional symptoms and can also be used to assess disease progression and to predict cardiovascular and cerebrovascular mortality. Once diagnosed, risk factor modification, symptomatic relief, and secondary prevention strategies with antiplatelet agents form the core of medical management of PAD.

From the Cardiovascular Division, Department of Medicine, University of Pennsylvania School of Medicine, Philadelphia. The author has no relevant financial interest in this article.

THIS ARTICLE HAS BEEN CITED BY OTHER ARTICLES

A Prognostic Risk Index for Long-term Mortality in Patients With Peripheral Arterial Disease
Feringa et al.
Arch Intern Med 2007;167:2482-2489.
ABSTRACT | FULL TEXT  

Genetic Susceptibility to Peripheral Arterial Disease: A Dark Corner in Vascular Biology
Knowles et al.
Arterioscler. Thromb. Vasc. Bio. 2007;27:2068-2078.
ABSTRACT | FULL TEXT  

Peripheral Arterial Disease: A Guide for Nephrologists
DeLoach and Mohler
CJASN 2007;2:839-846.
ABSTRACT | FULL TEXT  

Reproducibility and reliability of the ankle--brachial index as assessed by vascular experts, family physicians and nurses
Holland-Letz et al.
Vasc Med 2007;12:105-112.
ABSTRACT  

A clinical prediction model for the presence of peripheral arterial disease -- the benefit of screening individuals before initiation of measurement of the ankle--brachial index: an observational study
Bendermacher et al.
Vasc Med 2007;12:5-11.
ABSTRACT  

Impaired Exercise-Induced Blood Volume in Type 2 Diabetes With or Without Peripheral Arterial Disease Measured by Continuous-Wave Near-Infrared Spectroscopy
Mohler et al.
Diabetes Care 2006;29:1856-1859.
ABSTRACT | FULL TEXT  

Increased Pregnancy-Associated Plasma Protein-A as a Marker for Peripheral Atherosclerosis: Results from the Linz Peripheral Arterial Disease Study
Mueller et al.
Clin. Chem. 2006;52:1096-1103.
ABSTRACT | FULL TEXT  

Intraarterial MR Angiography and DSA in Patients with Peripheral Arterial Occlusive Disease: Prospective Comparison
Huegli et al.
Radiology 2006;239:901-908.
ABSTRACT | FULL TEXT  

Cardioprotective Medication Is Associated With Improved Survival in Patients With Peripheral Arterial Disease
Feringa et al.
J Am Coll Cardiol 2006;47:1182-1187.
ABSTRACT | FULL TEXT  

The Long-term Prognostic Value of the Resting and Postexercise Ankle-Brachial Index.
Feringa et al.
Arch Intern Med 2006;166:529-535.
ABSTRACT | FULL TEXT  

Peripheral Arterial Disease in Patients With Diabetes
Marso and Hiatt
J Am Coll Cardiol 2006;47:921-929.
ABSTRACT | FULL TEXT  

Validation of the auscultatory method for diagnosing peripheral arterial disease
Takahashi et al.
Fam Pract 2006;23:10-14.
ABSTRACT | FULL TEXT  

Prevalence of Lower-Extremity Disease in the U.S. Adult Population >=40 Years of Age With and Without Diabetes: 1999-2000 National Health and Nutrition Examination Survey
Gregg et al.
Diabetes Care 2004;27:1591-1597.
ABSTRACT | FULL TEXT