Multidisciplinary approach to the diagnosis and management of patients with peripheral arterial disease

Abstract

Peripheral arterial disease (PAD) is frequently diagnosed after permanent damage has occurred, resulting in a high rate of morbidity, amputation, and loss of life. Early and ongoing diagnosis and treatment is required for this progressive disease. Lifestyle modifications can prevent or delay disease progression and improve symptoms. Limb-sparing endovascular interventions can restore circulation based on appropriate diagnostic testing to pinpoint vascular targets, and intervention must occur as early as possible to ensure optimal clinical outcomes. An algorithm for the diagnosis and management of PAD was developed to enable a collaborative approach between the family practice and primary care physician or internist and various specialists that may include a diabetologist, endocrinologist, smoking cessation expert, hypertension and lipid specialist, endovascular interventionalist, vascular surgeon, orthopedist, neurologist, nurse practitioner, podiatrist, wound healing expert, and/or others. A multidisciplinary team working together has the greatest chance of providing optimal care for the patient with PAD and ensuring ongoing surveillance of the patient's overall health, ultimately resulting in better quality of life and increased longevity for patients with PAD.

Keywords: diagnosis; endovascular intervention; peripheral arterial disease.

Figure 1

Algorithm for the diagnosis and management of patients with PAD. Notes: Scheme shows the flow of patients at risk for PAD (A), with signs or symptoms of PAD (B), and with a diagnosis of PAD (C). Abbreviations: AAA, abdominal aortic aneurysm; ABI, ankle–brachial index; CAD, coronary artery disease; CHF, congestive heart failure; CTA, computed tomographic angiography; MRA, magnetic resonance angiography; PAD, peripheral arterial disease.