Clinical assessment of lower extremity peripheral arterial disease: Difference between revisions

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=2016 AHA/ACC Guideline on the Management of Patients With Lower Extremity Peripheral Artery Disease<ref name="pmid27840333">{{cite journal| author=Gerhard-Herman MD, Gornik HL, Barrett C, Barshes NR, Corriere MA, Drachman DE et al.| title=2016 AHA/ACC Guideline on the Management of Patients With Lower Extremity Peripheral Artery Disease: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. | journal=Circulation | year= 2016 | volume=  | issue=  | pages=  | pmid=27840333 | doi=10.1161/CIR.0000000000000471 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=27840333  }} </ref>=
=2016 AHA/ACC Guideline on the Management of Patients With Lower Extremity Peripheral Artery Disease<ref name="pmid27840333">{{cite journal| author=Gerhard-Herman MD, Gornik HL, Barrett C, Barshes NR, Corriere MA, Drachman DE et al.| title=2016 AHA/ACC Guideline on the Management of Patients With Lower Extremity Peripheral Artery Disease: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. | journal=Circulation | year= 2016 | volume=  | issue=  | pages=  | pmid=27840333 | doi=10.1161/CIR.0000000000000471 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=27840333  }} </ref>=


===Recommendations for History and Presentation===
===Recommendations for History and Presentation:===


{|class="wikitable"  
{|class="wikitable"  
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| colspan="1" style="text-align:center; background:LightGreen"|[[ACC AHA guidelines classification scheme#Classification of Recommendations|Class I]]
| colspan="1" style="text-align:center; background:LightGreen"|[[ACC AHA guidelines classification scheme#Classification of Recommendations|Class I]]
|-
|-
| bgcolor="LightGreen"|<nowiki>"</nowiki>'''1.''' Patients at increased risk of PAD ( (Table 1) should undergo a comprehensive medical history and a review of symptoms to assess for exertional leg symptoms, including claudication or other walking impairment, ischemic rest pain, and nonhealing wounds''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: BNR]])''<nowiki>"</nowiki>
| bgcolor="LightGreen"|<nowiki>"</nowiki>'''1.''' Patients at increased risk of [[Peripheral arterial disease|PAD]] ( (Table 1) should undergo a comprehensive medical history and a review of symptoms to assess for exertional leg symptoms, including [[claudication]] or other walking impairment, ischemic rest pain, and non healing wounds.''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: BNR]])''<nowiki>"</nowiki>
|-
|-
| bgcolor="LightGreen"|<nowiki>"</nowiki>'''2.''' Patients at increased risk of PAD (Table 1) should undergo vascular examination, including palpation of lower extremity pulses (i.e., femoral, popliteal, dorsalis pedis, and posterior tibial), auscultation for femoral bruits, and inspection of the legs and feet''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: BNR]])''<nowiki>"</nowiki>
| bgcolor="LightGreen"|<nowiki>"</nowiki>'''2.''' Patients at increased risk of [[Peripheral arterial disease|PAD]] (Table 1) should undergo vascular examination, including palpation of lower extremity pulses (i.e., femoral, popliteal, dorsalis pedis, and posterior tibial), auscultation for femoral bruits, and inspection of the legs and feet.''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: BNR]])''<nowiki>"</nowiki>
|-
|-
| bgcolor="LightGreen"|<nowiki>"</nowiki>'''3.''' Patients with PAD should undergo noninvasive blood pressure measurement in both arms at least once during the initial assessment''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: BNR]])''<nowiki>"</nowiki>
| bgcolor="LightGreen"|<nowiki>"</nowiki>'''3.''' Patients with [[Peripheral arterial disease|PAD]] should undergo noninvasive blood pressure measurement in both arms at least once during the initial assessment.''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: BNR]])''<nowiki>"</nowiki>
|-
|-
|}
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* Age ≥65 y
* Age ≥65 y


* Age 50–64 y, with risk factors for atherosclerosis (e.g., diabetes mellitus, history of smoking,  hyperlipidemia, hypertension) or family history of PAD
* Age 50–64 y, with risk factors for [[atherosclerosis]] (e.g., [[Diabetes mellitus|diabetes mellitus,]] history of [[smoking]][[hyperlipidemia]], [[hypertension]]) or family history of [[Peripheral arterial disease|PAD]]
* Age <50 y, with diabetes mellitus and 1 additional risk factor for atherosclerosis
* Age <50 y, with diabetes mellitus and 1 additional risk factor for atherosclerosis
* Individuals with known atherosclerotic disease in another vascular bed (e.g., coronary, carotid,  subclavian, renal, mesenteric artery stenosis, or AAA)
* Individuals with known atherosclerotic disease in another vascular bed (e.g., coronary, carotid,  subclavian, renal, mesenteric artery stenosis, or [[Abdominal aortic aneurysm|AAA]])
|-
|-
|<small><small>*Adapted from 2016 AHA/ACC Guideline on the Management of Patients With Lower Extremity Peripheral Artery Disease
|<small><small>*Adapted from 2016 AHA/ACC Guideline on the Management of Patients With Lower Extremity Peripheral Artery Disease

Latest revision as of 20:05, 22 November 2016


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AHA/ACC Guidelines on Management of Lower Extremity PAD

Guidelines for Clinical Assessment of Lower Extremity PAD

Guidelines for Diagnostic Testing for suspected PAD

Guidelines for Screening for Atherosclerotic Disease in Other Vascular Beds in patients with Lower Extremity PAD

Guidelines for Medical Therapy for Lower Extremity PAD

Guidelines for Structured Exercise Therapy for Lower Extremity PAD

Guidelines for Minimizing Tissue Loss in Lower Extremity PAD

Guidelines for Revascularization of Claudication in Lower Extremity PAD

Guidelines for Management of CLI in Lower Extremity PAD

Guidelines for Management of Acute Limb Ischemial in Lower Extremity PAD

Guidelines for Longitudinal Follow-up for Lower Extremity PAD

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Usama Talib, BSc, MD [2]

2016 AHA/ACC Guideline on the Management of Patients With Lower Extremity Peripheral Artery Disease[1]

Recommendations for History and Presentation:

Class I
"1. Patients at increased risk of PAD ( (Table 1) should undergo a comprehensive medical history and a review of symptoms to assess for exertional leg symptoms, including claudication or other walking impairment, ischemic rest pain, and non healing wounds.(Level of Evidence: BNR)"
"2. Patients at increased risk of PAD (Table 1) should undergo vascular examination, including palpation of lower extremity pulses (i.e., femoral, popliteal, dorsalis pedis, and posterior tibial), auscultation for femoral bruits, and inspection of the legs and feet.(Level of Evidence: BNR)"
"3. Patients with PAD should undergo noninvasive blood pressure measurement in both arms at least once during the initial assessment.(Level of Evidence: BNR)"


Table1: Patients at Increased Risk of PAD*
  • Age ≥65 y
  • Age 50–64 y, with risk factors for atherosclerosis (e.g., diabetes mellitus, history of smoking, hyperlipidemia, hypertension) or family history of PAD
  • Age <50 y, with diabetes mellitus and 1 additional risk factor for atherosclerosis
  • Individuals with known atherosclerotic disease in another vascular bed (e.g., coronary, carotid, subclavian, renal, mesenteric artery stenosis, or AAA)
*Adapted from 2016 AHA/ACC Guideline on the Management of Patients With Lower Extremity Peripheral Artery Disease

References

  1. Gerhard-Herman MD, Gornik HL, Barrett C, Barshes NR, Corriere MA, Drachman DE; et al. (2016). "2016 AHA/ACC Guideline on the Management of Patients With Lower Extremity Peripheral Artery Disease: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines". Circulation. doi:10.1161/CIR.0000000000000471. PMID 27840333.