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JAMA Clinical Guidelines Synopsis
October 11, 2016

Screening, Evaluation, and Treatment of Peripheral Arterial Disease

Author Affiliations
  • 1Department of Surgery, University of Chicago, Chicago, Illinois
  • 2Department of Medicine, University of Chicago, Chicago, Illinois

Copyright 2016 American Medical Association. All Rights Reserved. Applicable FARS/DFARS Restrictions Apply to Government Use.

JAMA. 2016;316(14):1486-1487. doi:10.1001/jama.2016.11103

Atherosclerotic PAD affects 8.5 million people in the United States1 and nearly 202 million people worldwide2; from 2000 to 2010, the prevalence of PAD increased by 23.5%.2 When atherosclerosis causes stenosis in the distal aorta and below, patients may be asymptomatic, experience exertional ischemic leg symptoms such as IC, or develop critical limb ischemia. Intermittent claudication is characterized by pain in a defined muscle group (typically the calf muscles) that is relieved by rest; IC significantly impairs both walking distance and quality of life. Treatment strategies for PAD that were evaluated in the guidelines range from lifestyle modification (diabetes control, exercise, and smoking cessation) to medical therapy (statins, antiplatelet agents, and other medications such as cilostazol and pentoxifylline), and revascularization (open or endovascular).3 This guideline synopsis focuses on 2 questions: whether to screen asymptomatic patients for PAD and whether treatment strategies (surgery; endovascular or exercise therapy) improve clinical outcomes compared with medications.