Clinical assessment of lower extremity peripheral arterial disease

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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

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 nonhealing 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