Peripheral Artery Disease

Question 1

Screening for PAD

Answer 1

Ankle-Brachial Index

USPSTF: I-uncertain

AHA/ACC (class 1, level of evidence B)
- 65+ or 55 w risk factors

Question 2

Understanding ABI

Answer 2

The ratio of the higher brachial systolic pressure and the
higher ankle systolic pressure for each leg:

ABI = Ankle systolic pressure / Higher brachial artery systolic
pressure

Question 3

Interpreting ABI

Answer 3

Noncompressible >1.30
Normal 1-1.29
Borderline 0.91-0.99
Mild/Mod 0.41-0.90
Severe Disease <0.40

Question 4

Further Investigation

Answer 4

● Segmental pressures

● Arterial dopplers

● CT angiography

● MR angiography

● Traditional angiography

Question 5

Clinical presentation

Answer 5

● Claudication

● Usually occurs one segment down from
stenosis

● Reproducible

● Critical limb ischemia

● Non-healing ulcers

Question 6

Treatment of PAD

Answer 6

● Preserve/improve functional capacity

● Cardiovascular risk reduction

● Preserve limb viability

Question 7

Functional capacity

Answer 7

● Supervised exercise program

● Atorvastatin

● Cilostazol

● Nafronyl (in europe)

● Surgical revascularization

Question 8

Cardiac Risk Reduction

Answer 8

Treatment of comorbidities (DM, HTN, HLP)

Smoking cessation

Antiplatelets
● Aspirin
● Clopidigrel
● Dual antiplatelet therapy, may be considered, if symptomatic
● Vorapaxar
● Warfarin not better than aspirin alone

Question 9

Preserve Limb Viability

Answer 9

● No clear evidence to support a specific strategy

● Antiplatelets

● Statins

● Exercise

● Surgical revascularization

Question 10

Voripaxar

Answer 10

● FDA approved 5/24/14

● (platelet) Thrombin receptor (PAR-1) antagonist

● Reduces risk of MACE, increases risk of
hemorrhage