Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2014 Apr 7;2014(4):CD010835.
doi: 10.1002/14651858.CD010835.pub2.

Screening for peripheral arterial disease

Alina Andras  1 , Bart Ferket
Affiliations

Screening for peripheral arterial disease

Alina Andras et al. Cochrane Database Syst Rev. .

Abstract

Background: In the general population, up to 10% of people younger than 70 years and 15% to 20% of people older than 70 years have peripheral arterial disease (PAD). Symptomatic and asymptomatic PAD has an estimated prevalence of 13% in the over 50 years age group. However, asymptomatic PAD can account for up to 75% of PAD patients and only 10% of PAD patients have typical intermittent claudication. People with PAD are at an increased risk of death, heart and cerebrovascular disease and are recommended to receive treatment to manage their cardiac risk. They suffer from significant functional limitations in their daily activities and the most severely affected are at risk of limb loss. Many people with PAD do not have any symptoms. Only some people have discomfort or pain in the lower legs when walking, so PAD often goes undetected. Given the high incidence of asymptomatic and undiagnosed PAD, it is important to determine the effectiveness of a screening intervention in preventing cardiovascular adverse outcomes, both fatal and non-fatal.

Objectives: To determine the effectiveness of screening for PAD in asymptomatic and undiagnosed individuals in terms of reduction of all-cause mortality, cardiovascular events (for example myocardial infarction and stroke), morbidity from PAD (intermittent claudication, amputation, reduced walking distance) and improvement in quality of life.

Search methods: The Cochrane Peripheral Vascular Diseases Group Trials Search Co-ordinator searched the Specialised Register (last searched November 2013) and CENTRAL (2013, Issue 10).

Selection criteria: All published and unpublished randomised controlled trials (RCTs) of screening for PAD were sought without language restriction.

Data collection and analysis: Studies identified for potential inclusion in the review were independently assessed by both review authors. We planned to conduct data collection and analysis in accordance with the Cochrane Handbook for Systematic Review of Interventions.

Main results: No RCTs were identified that met the inclusion criteria.

Authors' conclusions: Unfortunately, no randomised controlled trial data are available regarding screening for PAD. Therefore, we are unable to determine the effects of screening for PAD in order to guide decision making by healthcare providers and planners. High quality randomised controlled trials evaluating the effectiveness of screening for PAD in asymptomatic and undiagnosed individuals in terms of reduction of all-cause mortality, cardiovascular events (for example myocardial infarction and stroke), morbidity from PAD (intermittent claudication, amputation, reduced walking distance) and improvement in quality of life are needed.

PubMed Disclaimer

Conflict of interest statement

None known

Figures

1
1
Study flow diagram.
See this image and copyright information in PMC

Update of

  • doi: 10.1002/14651858.CD010835

References

References to studies excluded from this review

Behar 2013 {published data only}
    1. Behar T, Bosson JL, Galanaud JP, Thoret S, Rolland C, Bura‐Rivière A, et al. Prevalence and risk factors of peripheral arterial disease in an outpatient screening campaign [Évaluation de la prévalence et des facteurs de risque de l’artériopathie oblitérante des membres inférieurs dans le cadre d’une campagne de dépistage ambulatoire]. Journal des Maladies Vasculaires 2013;38(1):22‐8. - PubMed
Bergiers 2011 {published data only}
    1. Bergiers S, Vaes B, Degryse J. To screen or not to screen for peripheral arterial disease in subjects aged 80 and over in primary health care: a cross‐sectional analysis from the BELFRAIL study. BMC Family Practice 2011;12:39. - PMC - PubMed
Delgado‐Osorio {published data only}
    1. Delgado‐Osorio H, Franqui‐Rivera H, García‐Palmieri MR, Díaz‐Santana MV, Alvarez M. A peripheral artery disease screening study in Puerto Rico. Boletín de la Asociación Médica de Puerto Rico 2011;103(4):17‐21. - PubMed
Farkas 2012 {published data only}
    1. Farkas K, Járai Z, Kolossváry E, Ludányi A, Clement DL, Kiss I, ERV Study Group. High prevalence of peripheral arterial disease in hypertensive patients: the evaluation of ankle‐brachial index in Hungarian hypertensives screening program. Journal of Hypertension 2012;30(8):1526‐32. - PubMed
Kravos 2009 {published data only}
    1. Kravos A, Bubnič‐Sotošek K. Ankle‐brachial Index screening for peripheral artery disease in asymptomatic patients between 50 and 70 years of age. Journal of International Medical Research 2009;37(5):1611‐9. - PubMed
Mourad 2009 {published data only}
    1. Mourad JJ, Cacoub P, Collet JP, Becker F, Pinel JF, Huet D, et al. Screening of unrecognized peripheral arterial disease (PAD) using ankle‐brachial index in high cardiovascular risk patients free from symptomatic PAD. Journal of Vascular Surgery 2009;50(3):572‐80. - PubMed
Taylor‐Piliae 2011 {published data only}
    1. Taylor‐Piliae RE, Fair JM, Varady AN, Hlatky MA, Norton LC, Iribarren C, et al. Ankle brachial index screening in asymptomatic older adults. American Heart Journal 2011;161(5):979‐85. - PMC - PubMed

References to ongoing studies

Viborg 2014 {published data only (unpublished sought but not used)}
    1. Grondal N, Henneberg EW, Lindholt JS. The Viborg vascular (VIVA) randomised screening trial: design, methods and preliminary findings. European Society for Vascular Surgery Annual Meeting; 2009; Oslo, Norway 2009.
    1. Grondal N, Sogaard R, Henneberg EW, Lindholt JS. The Viborg vascular (VIVA) screening trial of 65‐74 year old men in the central region of Denmark: Study protocol. Trials 2010;11:67. - PMC - PubMed
    1. NCT00662480. Randomized preventive vascular screening trial of 65‐74 year old men in the central region of Denmark. NCT00662480. http://clinicaltrials.gov/ct2/show/record/NCT00662480 (accessed 9 January 2014).

Additional references

Aboyans 2012
    1. Aboyans V, Criqui MH, Abraham P, Allison MA, Creager MA, Diehm C, et al. Measurement and interpretation of the ankle‐brachial index: a scientific statement from the American Heart Association. Circulation 2012;126(24):2890‐909. - PubMed
Abramson 2005
    1. Abramson BL, Huckell V, Anand S, Forbes T, Gupta A, Harris K, et al. Canadian Cardiovascular Society Consensus Conference: peripheral arterial disease ‐ executive summary. Canadian Journal of Cardiology 2005;21:997‐1006. - PubMed
ACCF/AHA 2010
    1. Greenland P, Alpert JS, Beller GA, Benjamin EJ, Budoff MJ, Fayad ZA, et al. 2010 ACCF/AHA Guideline for assessment of cardiovascular risk in asymptomatic adults: a report of the American College of Cardiology Foundation/American Heart Association Task Force on practice guidelines. Journal of the American College of Cardiology 2010;56(25):e50‐e103. - PubMed
Allen 2008
    1. Allen J, Overbeck K, Nath AF, Murray A, Stansby G. A prospective comparison of bilateral photoplethysmography versus the ankle‐brachial pressure index for detecting and quantifying lower limb peripheral arterial disease. Journal of Vascular Surgery 2008;47(4):794‐802. - PubMed
Ankle Brachial Index Collaboration 2008
    1. The Ankle Brachial Index Collaboration, Fowkes FG, Murray GD, Butcher I, Heald CL, Lee RJ, et al. Ankle brachial index combined with Framingham risk score to predict cardiovascular events and mortality: a meta‐analysis. JAMA 2008;300(2):197‐208. - PMC - PubMed
Anon 2006
    1. Anonymous. Screening for peripheral arterial disease: recommendation statement. American Family Physician 2006;73:497‐500. - PubMed
Beckman 2006
    1. Beckman JA, Jaff MR, Creager MA. The United States preventive services task force recommendation statement on screening for peripheral arterial disease: more harm than benefit?. Circulation 2006;114(8):861‐6. - PubMed
Bendermacher 2007
    1. Bendermacher BL, Teijink JA, Willigendael EM, Bartelink ML, Peters RJ, Bie RA, et al. 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. Vascular Medicine 2007;12:5‐11. - PubMed
Bhasin 2007
    1. Bhasin N, Scott DJA. Ankle brachial pressure index: identifying cardiovascular risk and improving diagnostic accuracy. Journal of the Royal Society of Medicine 2007;100(1):4‐5. - PMC - PubMed
CCS 2013
    1. Anderson TJ, Grégoire J, Hegele RA, Couture P, Mancini GB, McPherson R, et al. 2012 update of the Canadian Cardiovascular Society guidelines for the diagnosis and treatment of dyslipidemia for the prevention of cardiovascular disease in the adult. Canadian Journal of Cardiology 2013;29(2):151‐67. - PubMed
Collins 2007
    1. Collins R, Cranny G, Burch J, Aguiar‐Ibáñez R, Craig D, Wright K, et al. A systematic review of duplex ultrasound, magnetic resonance angiography and computed tomography angiography for the diagnosis and assessment of symptomatic, lower limb peripheral arterial disease. Health Technology Assessment 2007;11(20):iii‐iv, xi‐xiii, 1‐184. - PubMed
Criqui 1985
    1. Criqui MH, Fronek A, Klauber MR, Barrett‐Connor E, Gabriel S. The sensitivity, specificity, and predictive value of traditional clinical evaluation of peripheral arterial disease: results from noninvasive testing in a defined population. Circulation 1985;71(3):516‐22. - PubMed
Deeks 2011
    1. Deeks JJ, Higgins JPT, Altman DG (editors). Chapter 9: Analysis data and undertaking meta‐analyses. In: Higgins JPT, Green S (editors). Cochrane Handbook for Systematic Reviews of Interventions Version 5.1.0 [updated March 2011]. The Cochrane Collaboration, 2011. Available from www.cochrane‐handbook.org.
Donnelly 2000
    1. Donnelly R, Hinwood D, London NJM. ABC of arterial and venous disease. Non‐invasive methods of arterial and venous assessment. BMJ 2000;320(7236):698‐701. - PMC - PubMed
Ferket 2012
    1. Ferket BS, Spronk S, Colkesen EB, Hunink MG. Systematic review of guidelines on peripheral artery disease screening. American Journal of Medicine 2013;125(2):198‐208, e3. - PubMed
Fowkes 2014
    1. Fowkes F, Murray G, Butcher I, Folsom A, Hirsch A, Couper D, et al. Development and validation of an ankle brachial index risk model for the prediction of cardiovascular events. European Journal of Preventive Cardiology 2014;21(3):310‐20. - PMC - PubMed
Genest 2009
    1. Genest J, McPherson R, Frohlich J, Anderson T, Campbell N, Carpentier A, et al. 2009 Canadian Cardiovascular Society/Canadian guidelines for the diagnosis and treatment of dyslipidemia and prevention of cardiovascular disease in the adult ‐ 2009 recommendations. Canadian Journal of Cardiology 2009;25:567‐79. - PMC - PubMed
Goyen 2005
    1. Goyen M, Edelman M, Perreault P, O'Riordan E, Bertoni H, Taylor J, et al. MR angiography of aortoiliac occlusive disease: a phase III study of the safety and effectiveness of the blood‐pool contrast agent MS‐325. Radiology 2005;236(3):825‐33. - PubMed
Grade Working Group 2004
    1. GRADE Working Group 2004. Grading quality of evidence and strength of recommendations. BMJ 2004;328:1490‐4. - PMC - PubMed
Grundy 2004
    1. Grundy SM, Cleeman JI, Merz CN, Brewer HB Jr, Clark LT, Hunninghake DB, et al. Implications of recent clinical trials for the National Cholesterol Education Program Adult Treatment Panel III guidelines. Circulation 2004;110:227‐39. - PubMed
Heald 2006
    1. Heald CL, Fowkes FG, Murray GD, Price JF, Ankle Brachial Index Collaboration. Risk of mortality and cardiovascular disease associated with the ankle‐brachial index: systematic review. Atherosclerosis 2006;189(1):61‐9. - PubMed
Higgins 2011
    1. Higgins JPT, Altman DG, Sterne JAC (editors). Chapter 8: Assessing risk of bias in included studies. In: Higgins JPT, Green S (editors). Cochrane Handbook for Systematic Reviews of Interventions Version 5.1.0 [updated March 2011]. The Cochrane Collaboration, 2011. Available from www.cochrane‐handbook.org.
Hirsch 2001
    1. Hirsch AT, Criqui MH, Treat‐Jacobson D, Regensteiner JG, Creager MA, Olin JW, et al. Peripheral arterial disease detection, awareness, and treatment in primary care. JAMA 2001;286(11):1317‐24. - PubMed
Hirsch 2006
    1. Hirsch AT, Haskal ZJ, Hertzer NR, Bakal CW, Creager MA, Halperin JL, et al. ACC/AHA 2005 Practice Guidelines for the management of patients with peripheral arterial disease (lower extremity, renal, mesenteric, and abdominal aortic): a collaborative report from the American Association for Vascular Surgery/Society for Vascular Surgery, Society for Cardiovascular Angiography and Interventions, Society for Vascular Medicine and Biology, Society of Interventional Radiology, and the ACC/AHA Task Force on Practice Guidelines (Writing Committee to Develop Guidelines for the Management of Patients With Peripheral Arterial Disease): endorsed by the American Association of Cardiovascular and Pulmonary Rehabilitation; National Heart, Lung, and Blood Institute; Society for Vascular Nursing; TransAtlantic Inter‐Society Consensus; and Vascular Disease Foundation. Circulation 2006;113:e463‐654. - PubMed
Hooi 2004
    1. Hooi JD, Kester AD, Stoffers HE, Rinkens PE, Knottnerus JA, Ree JW. Asymptomatic peripheral arterial occlusive disease predicted cardiovascular morbidity and mortality in a 7‐year follow‐up study. Journal of Clinical Epidemiology 2004;57(3):294‐300. - PubMed
Høyer 2013
    1. Høyer C, Sandermann J, Petersen LJ. The toe‐brachial index in the diagnosis of peripheral arterial disease. Journal of Vascular Surgery 2013;58(1):231‐8. - PubMed
Inglis 2013
    1. Inglis SC, Hermis A, Shehab S, Newton PJ, Lal S, Davidson PM. Peripheral arterial disease and chronic heart failure: a dangerous mix. Heart Failure Reviews 2013;18(4):457‐64. - PubMed
Khan 2006
    1. Khan NA, Rahim SA, Anand SS, Simel DL, Panju A. Does the clinical examination predict lower extremity peripheral arterial disease?. JAMA 2006;295(5):536‐46. - PubMed
Leng 1992
    1. Leng GC, Fowkes FG. The Edinburgh Claudication Questionnaire: an improved version of the WHO/Rose Questionnaire for use in epidemiological surveys. Journal of Clinical Epidemiology 1992;45(10):1101‐9. - PubMed
Macleod‐Roberts 1995
    1. MacLeod‐Roberts J. Vascular assessment. In: Merriman LM, Tollafield DR editor(s). Assessment of the lower limb. 1st Edition. Edinburgh: Churchill Livingstone, 1995:79‐115.
McDermott 2000
    1. McDermott MM, Criqui MH, Liu K, Guralnik JM, Greenland P, Martin GJ, et al. Lower ankle/brachial index, as calculated by averaging the dorsalis pedis and posterior tibial arterial pressures, and association with leg functioning in peripheral arterial disease. Journal of Vascular Surgery 2000;32(6):1164‐71. - PubMed
Mohler 2012
    1. Mohler ER 3rd. Screening for peripheral artery disease. Circulation 2012;126:e111‐2. - PubMed
NCEP 2002
    1. National Cholesterol Education Program. Third report of the National Cholesterol Education Program (NCEP) expert panel on detection, evaluation and treatment of high blood cholesterol in adults (adult treatment panel III) final report. Circulation 2002;106:3143‐421. - PubMed
NICE 2012
    1. National Institute for Health and Clinical Excellence. Lower limb peripheral arterial disease (CG147). NICE clinical guidelines CG147 2012.
Oates 2012
    1. Oates CP, Allen J, Stansby G. Beyond the ankle‐brachial pressure index for the diagnosis of peripheral arterial disease‐‐time for a new look at photoplethysmography. Angiology 2012;64(7):492‐3. - PubMed
Parameswaran 2005
    1. Parameswaran GI, Brand K, Dolan J. Pulse oximetry as a potential screening tool for lower extremity arterial disease in asymptomatic patients with diabetes mellitus. Archives of Internal Medicine 2005;165(4):442‐6. - PubMed
Ramos 2011
    1. Ramos R, Baena‐Díez JM, Quesada M, Solanas P, Subirana I, Sala J, et al. Derivation and validation of REASON: a risk score identifying candidates to screen for peripheral arterial disease using ankle brachial index. Atherosclerosis 2011;214:474‐9. - PubMed
RevMan 2011 [Computer program]
    1. The Nordic Cochrane Centre, The Cochrane Collaboration. Review Manager. Version 5.1. Copenhagen: The Nordic Cochrane Centre, The Cochrane Collaboration, 2011.
Shammas 2007
    1. Shammas NW. Epidemiology, classification, and modifiable risk factors of peripheral arterial disease. Vascular Health Risk Management 2007;3(2):229‐34. - PMC - PubMed
SIGN 2007
    1. Scottish Intercollegiate Guidelines Network (SIGN). Diagnosis and management of peripheral arterial disease. A national clinical guideline. www.sign.ac.uk (accessed 23 July 2013).
Sterne 2011
    1. Sterne JAC, Egger M, Moher D (editors). Chapter 10: Addressing reporting biases. In: Higgins JPT, Green S (editors). Cochrane Handbook for Systematic Review of Interventions. Version 5.1.0 [updated March 2011]. The Cochrane Collaboration, 2011. Available from www.cochrane‐handbook.org.
TASC 2007
    1. Norgren L, Hiatt WR, Dormandy JA, Nehler MR, Harris KA, Fowkes FGR, on behalf of the TASC II Working Group. Inter‐society consensus for the management of peripheral arterial disease (TASC II). European Journal of Vascular and Endovascular Surgery 2007;33 Suppl 1:S1‐S75. - PubMed
Twine 2009
    1. Twine CP, Coulston J, Shandall A, McLain AD. Angioplasty versus stenting for superficial femoral artery lesions. Cochrane Database of Systematic Reviews 2009, Issue 2. [DOI: 10.1002/14651858.CD006767.pub2] - DOI - PubMed
USPSTF 2009
    1. U.S. Preventive Services Task Force. Using nontraditional risk factors in coronary heart disease risk assessment. Annals of Internal Medicine 2009;151:474‐82. - PubMed
USPSTF 2013
    1. U.S. Preventive Services Task Force. The ankle brachial index for peripheral artery disease screening and cardiovascular disease prediction in asymptomatic adults: a systematic evidence review for the U.S. Preventive Services Task Force. Available from http://www.uspreventiveservicestaskforce.org/uspstf12/pad/pades100.pdf (accessed 16 January 2013).

Publication types

LinkOut - more resources