The AHA Guidelines and Scientific Statements Handbook

The AHA Guidelines and Scientifi c Statements Handbook

Classic claudication symptoms:

Muscle fatigue, cramping, or pain that reproducibly begins during exercise and

that promptly resolves with rest

Chart document the history of walking impairment (pain-free and total walking

distance) and specific lifestyle limitations

Document pulse examination

ABI less than or equal to 0.90

Confirmed PAD diagnosis

Go to Figure 9.5, Treatment of Claudication

Risk factor normalization:

Immediate smoking cessation

Treat hypertension: JNC-7 guidelines

Treat lipids: NCEP ATP III guidelines

Treat diabetes mellitus: HbAlc less than 7%*

Pharmacological risk reduction:

Antiplatelet therapy

(ACE inhibition;† Class IIa)

ABI

Exercise ABI

(TBI, segmental

pressure, or duplex

ultrasound

examination)

No PAD or

consider arterial

entrapment

syndromes

ABI greater

than 0.90

Abnormal

results

Normal

results

Fig. 9.4 Diagnosis of claudication and systemic risk treatment.

• It is not yet proven that treatment of diabetes mellitus will signifi cantly reduce peripheral arterial disease (PAD)-specifi c (limb ischemic) endpoints. Primary
  treatment of diabetes mellitus should be continued according to established guidelines.
  † The benefi t of angiotensin-converting enzyme (ACE)-inhibition in individuals without claudication has not been specifi cally documented in prospective clinical
  trials, but has been extrapolated from other “at risk” populations.
  ABI, ankle-brachial index; HgbA1c, hemoglobin A; JNC-7, Seventh Report of the Joint National Committee on the Prevention, Detection, Evaluation, and Treatment
  of High Blood Pressure; LOE, level of evidence; NCEP ATP-III, National Cholesterol Education Program Adult Treatment Panel III.

Exercise and lower extremity pad rehabilitation
See Table 9.7.
Class I
1 A program of supervised exercise training is rec-
ommended as an initial treatment modality for
patients with intermittent claudication. (Level of
Evidence: A)
2 Supervised exercise training should be performed
for a minimum of 30 to 45 minutes, in sessions

performed at least three times per week for a

minimum of 12 weeks. (Level of Evidence: A)

Class IIb

The usefulness of unsupervised exercise programs is

not well established as an effective initial treatment

modality for patients with intermittent claudication.

(Level of Evidence: B)