Peripheral Artery Disease Management

Introduction to PAD Management

The American College of Cardiology recommends a comprehensive program of supervised exercise training, optimal medical therapy, risk factor modification, and revascularization when appropriate to reduce morbidity, mortality, and improve quality of life in patients with Peripheral Artery Disease (PAD) 1, 2

Smoking cessation is essential for all patients with PAD who smoke, with counseling and pharmacotherapy, as recommended by the American College of Cardiology and the American Heart Association 1, 2
The American Heart Association recommends structured exercise programs with a frequency of at least three times per week, session duration of at least 30 minutes, and program duration of at least 12 weeks for patients with PAD 3, 4
Patients with PAD should exercise to moderate-severe claudication pain to maximize walking performance improvements, as suggested by the European Heart Journal 3

The American College of Cardiology recommends low-dose rivaroxaban (2.5 mg twice daily) combined with low-dose aspirin to reduce major adverse cardiovascular events (MACE) and major adverse limb events (MALE) in symptomatic PAD patients 4
Single antiplatelet therapy with aspirin (75-100 mg daily) or clopidogrel (75 mg daily) is recommended for secondary prevention by the American College of Cardiology and the American Heart Association 1, 6

The American College of Cardiology indicates statin therapy for all patients with PAD, as stated in Circulation 2
Target LDL-C should be <70 mg/dL for very high-risk PAD patients, according to the American College of Cardiology 5

Antihypertensive therapy should be administered to reduce the risk of MI, stroke, heart failure, and cardiovascular death in patients with PAD, as recommended by the American College of Cardiology and the American Heart Association 1, 2
Target blood pressure should be <140/90 mmHg for patients without diabetes and <130/80 mmHg for patients with diabetes or chronic kidney disease, according to the American College of Cardiology 1

Management of diabetes should be coordinated between healthcare team members to benefit patients with critical limb ischemia, as suggested by the American Heart Association 2

Supervised exercise training (SET) is recommended as first-line therapy for patients with claudication to improve functional status and quality of life by the European Heart Journal and the American Heart Association 3, 2

Revascularization (endovascular, surgical, or hybrid) should be considered for patients with chronic limb-threatening ischemia to prevent limb loss and for patients with claudication not responsive to medical therapy and structured exercise, as recommended by the American College of Cardiology 4

Patients with PAD should receive periodic clinical evaluation including assessment of cardiovascular risk factors, limb symptoms, and functional status, as suggested by the American College of Cardiology 7
After revascularization, patients should undergo regular follow-up with ABI measurement, according to the American College of Cardiology 7

Patients with PAD should be screened for abdominal aortic aneurysm, as recommended by the American College of Cardiology 5
Care for patients with PAD, especially those with chronic limb-threatening ischemia, is optimized when delivered by a multispecialty care team, according to the American College of Cardiology 4