The AHA Guidelines and Scientific Statements Handbook

Chapter 9 Lower Extremity Peripheral Artery Disease

Confirmed PAD diagnosisLifestyle-limiting symptoms

Three-month trial

Three-month trial

No significant

functional disability

• No claudication treatment required.• Follow-up visits at least annually to monitor for development of leg, coronary, or cerebrovascular ischemic symptoms.

Further anatomic definition

by more extensive

noninvasive or

angiographic diagnostic

techniques

Lifestyle-limiting symptoms with

evidence of inflow disease*

Endovascular

therapy or surgical bypass per anatomy

Clinical improvement:

Preprogram and Follow-up visitsat least annually

postprogram exercise

testing for efficacy

Significant disability

despite medical therapy and/or

inflow endovascular therapy, with documentation of outflow† PAD, with favorable procedural anatomy

and procedural risk-benefit ratio

Evaluation for additional endovascular or

surgical revascularization

Pharmacological

therapy:Cilostazol

(Pentoxifylline)

Supervised

exercise program

Fig. 9.5

Treatment of claudication.

* Infl ow disease should be suspected in individuals with gluteal or thigh claudication and femoral pulse diminution or bruit and

should be confi rmed by noninvasive vascular laboratory diagnostic evidence of aortoiliac stenosis.

† Outfl ow disease represents femoropopliteal and infrapopliteal stenoses (the presence of occlusive lesions in the lower extremi

ty arterial tree below the inguinal ligament from the common femoral artery to the pedal vessels).