Riktlinjer för screening

American College of Cardiology/American Heart Association (ACC/AHA) riktlinjer för PAD har identifierat följande grupper med en högre prevalens av PAD där screening kan vara lämplig¹²:

• Ålder ≥65 years
• Ålder 50 to 64 years with Riskfaktorer for atherosclerosis (e.g., diabetes mellitus, history of smoking, hyperlipidemia, hypertension) or Familjehistoria of PAD
• Ålder <50 with diabetes mellitus and one additional risk factor for atherosclerosis
  Known atherosclerosis at other sites (e.g., coronary, carotid, renal artery disease)
• A history of claudication, other non-joint related exertional lower extremity symptoms, impaired walking function, and/or ischemic rest pain
• Physical presentation with abnormal lower extremity pulses, vascular bruit, non-healing lower extremity wound or gangrene, or other suggestive physical findings (e.g., elevation pallor/dependent rubor)

Diagnosis of PAD

Patients at risk for PAD should undergo a comprehensive vascular examination and PAD screening should always include questions related to a history of walking impairment, extremity pain that might be due to ischemia, and the presence of non-healing wounds. Since the presentation of PAD can vary, patients with Riskfaktorer for PAD who report no or few symptoms should be asked about functional capacity and decline in activity over time, including exertional non-joint related pain.

For many patients, a history of Riskfaktorer or symptoms of PAD, in combination with physical examination findings, is sufficient to establish a diagnosis of PAD. Patients with atypical symptoms or abnormal physical findings require confirmation with an Ankle-Brachial Index (ABI) to establish the diagnosis of PAD. The ACC/AHA guidelines recommend for patients with a history or physical examination findings suggestive of PAD, a resting ABI, with or without segmental pressures and waveforms, is recommended to establish the diagnosis.

Clinical classification of chronic lower extremity PAD is based upon the severity of symptoms and differentiates the advanced signs of PAD, tissue loss, such as ulceration and gangrene. The later stÅlders of the disease, ischemic rest pain and tissue loss, are considered critical limb ischemia (CLI).

Rutherford Clinical Classification

Critical Limb Ischemia

Critical limb ischemia presents as ischemic Vilosmärta with or without tissue loss, such as skin ulceration, diabetic ulcer or Kallbrand. CLI is estimated to occur in 1 to 2 percent of patients with symptomatic PAD.

Patients with CLI are at risk for limb loss with an associated 1-year limb loss rate of 20% and a 1-year mortality rate of 20%.¹⁵ Estimates show that 33% of CLI patients with an amputation will have a contralateral amputation within 3 to 5 years.¹⁶ It has been reported in a retrospective analysis, however, that 54% of CLI patients had no vascular procedures performed in the year before major lower extremity amputation¹⁷ . Early intervention with the right network is key to reduce the chances of amputation.

Livskvalité

Människor med förlust av extremiteter på grund av CLI upplever betydligt lägre hälsostatus, hög dödlighet och ökad risk för hjärt-kärlsjukdomar, fetma, led- och skelettproblem, plus höga frekvenser av depression och känslomässigt lidande.^22-27

Studier uppskattar den 5-åriga dödligheten för personer med amputation på grund av PAD till mellan 50 % och 74 %, vilket är högre än kolorektal cancer, bröstcancer och kranskärlssjukdom (CAD).^{28 -29}