Screening, Evaluation, and Treatment of Peripheral Arterial Disease

GUIDELINE TITLE Society for Vascular Surgery Practice Guidelines for Atherosclerotic Occlusive Disease of the Lower Extremities: Management of Asymptomatic Disease and Claudication DEVELOPER Society for Vascular Surgery (SVS) RELEASE DATE March 2015 FUNDING SOURCE SVS TARGET POPULATION Patients with asymptomatic peripheral arterial disease (PAD) and patients with intermittent claudication MAJOR RECOMMENDATIONS Screening for lower extremity PAD in the absence of risk factors, history signs, or symptoms of PAD should not be done. * The ankle-brachial index (ABI) is the first-line noninvasive test to establish a diagnosis of PAD in individuals with symptoms or signs suggestive of disease. When the ABI is borderline or normal (>0.9) and symptoms of claudication are suggestive, the committee recommends an exercise ABI. * Multidisciplinary comprehensive smoking cessation interventions for patients with asymptomatic PAD who use tobacco are recommended. * Invasive treatments for PAD in the absence of symptoms, regardless of hemodynamic measures or imaging findings demonstrating PAD, should not be done. * A supervised exercise program (walking a minimum of 3 times per week, 30 to 60 minutes per session, for at least 12 weeks) as first-line therapy to all suitable patients with intermittent claudication (IC) is recommended.