AHA/ACC 2016: PAD

Question 1

What to review for if a patient is at increased risk of PAD

Answer 1

Exertional leg symptoms like walking impairment, ischemic rest pain, nonhealing wounds

Question 2

What sort of examinations should a patient at risk for PAD undergo

Answer 2

Vascular examinations that include palpitation of lower extremity pulses, auscultation for femoral bruits, and inspection of legs and feet
Also BP measurement in Both arms at least once during the initial assessment

Question 3

If history and physical exam suggest PAD (or even if they don’t but as long as they have an increased risk of PAD), what to look at next
And then what to look at if that is high

Answer 3

resting ankle-brachial index (ABI)
then toe-brachial index (TBI) if ABI is high
if ABI is borderline or normal, can use exercise treadmill ABI testing

Question 4

If symptomatic PAD, recommended medication therapy

Answer 4

ASA alone (75 - 325 mg per day) or 
Clopidogrel alone (75 mg daily)

Question 5

If asymptomatic PAD, is it reasonable to use antiplatelet therapy?

Answer 5

Yes

Question 6

When could DAPT be considered in the setting of symptomatic PAD?

Answer 6

After lower extremity revascularization, to reduce the risk of limb ischemia

Question 7

Should anticoagulation be used to reduce the risk of cardiovascular ischemic events in patients with PAD?

Answer 7

No