Peripheral Artery Disease Management

Patient Assessment and Compression Therapy

The American College of Cardiology recommends measuring the ankle-brachial index (ABI) immediately to determine arterial perfusion status in patients with suspected Peripheral Artery Disease (PAD) 1, 2
The American College of Cardiology suggests checking toe pressures and transcutaneous oxygen pressure (TcPO2) in diabetic patients, even if ABI appears normal, as calcified vessels can give falsely elevated readings 3
Duplex Doppler ultrasound should be performed to evaluate the arterial system if PAD is suspected, as recommended by the American College of Cardiology 3

The American College of Cardiology states that an ABI <0.6 is an absolute contraindication for compression therapy, and it should never be used without first checking arterial status 3
For patients with ABI 0.6-0.9, the American College of Cardiology recommends reduced compression only, limiting to 20-30 mmHg graduated compression, which has been shown safe for healing venous ulcers in this range 3
The American College of Cardiology permits standard compression (20-40 mmHg graduated compression) for venous insufficiency in patients with ABI ≥0.9 3

The American College of Cardiology recommends identifying the underlying cause of lower extremity edema, as bilateral edema is rarely venous disease alone, and excluding cardiac, renal, hepatic, and medication-related causes 3
Optimizing cardiovascular risk reduction, including statins targeting LDL <55 mg/dL, antiplatelet therapy, and blood pressure control to <140/90 mmHg, is crucial for PAD patients with edema, as recommended by the American College of Cardiology 1, 3
Implementing proper foot care without compression, including daily inspection, appropriate footwear, skin cleansing, and topical moisturizing creams, is essential for PAD patients, as suggested by the American College of Cardiology 5, 6, 7

Reduced compression (20-30 mmHg) is safe and effective for healing venous ulcers in patients with both PAD and venous insufficiency (ABI 0.6-0.9), according to the American College of Cardiology 3
Diabetic foot ulcers typically heal if toe pressure >55 mmHg and TcPO2 >50 mmHg, as stated by the American College of Cardiology 3
Initiating aggressive cardiovascular risk reduction alongside any compression therapy is crucial for patients with mixed arterial-venous disease, as recommended by the American College of Cardiology 3