Peripheral Arterial Disease

Key Points

• Patients must be encouraged and supported to stop smoking and to avoid secondhand smoke (Smith et al., 2001) (SOR: A).

• Nicotine replacement therapies to prevent withdrawal symptoms (bupropion, varenicline) are useful aids for tobacco cessation (SOR: A).

• Patients should participate in regular aerobic exercise for at least 30 minutes a day three or four times weekly. Walking improves claudication (SOR: A).

• Patients should receive dietary counseling and be encouraged to achieve an ideal body weight (SOR: A).

• Pedal pulses should be palpated as part of the routine physical examination in all patients at risk for atherosclerosis (SOR: A).

• Diabetic patients should undergo yearly foot examinations that consist of vascular, neurologic, musculoskeletal, and skin evaluation (SOR: A).

• Patients with absent pulses or symptoms suggestive of intermittent claudication should undergo a noninvasive vascular study. For patients with calcified, noncompressible vessels, the toe-brachial index can be used instead of the ankle-brachial index (ABI).

• Patients with an abnormal resting ABI, or postexercise ABI less than 0.9, should have CTA or MRA

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