Screening Guidelines

The American College of Cardiology/American Heart Association (ACC/AHA) guidelines on PAD have identified the following groups with a higher prevalence of PAD where screening may be appropriate:

Alder ≥65 years
Alder 50 to 64 years with Risikofaktorer for atherosclerosis (e.g., diabetes mellitus, history of smoking, hyperlipidemia, hypertension) or Familiehistorie of PAD
Alder <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 Symptomer, impaired walking function, and/or ischemic rest pain
Physical presentation with abnormal lower extremity pulses, vascular bruit, non-healing lower extremity wound or Koldbrand, 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 Risikofaktorer for PAD who report no or few Symptomer should be asked about functional capacity and decline in activity over time, including exertional non-joint related pain. sup12

For many patients, a history of Risikofaktorer or Symptomer of PAD, in combination with physical examination findings, is sufficient to establish a diagnosis of PAD. Patients with atypical Symptomer 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. sup 12

Clinical classification of chronic lower extremity PAD is based upon the severity of Symptomer and differentiates the advanced signs of PAD, tissue loss, such as ulceration and Koldbrand. The later stAlders of the disease, ischemic rest pain and tissue loss, are considered critical limb ischemia (CLI).sup13

Rutherford Clinical Classification

Critical Limb Ischemia

Critical limb ischemia presents as ischemic Smerter ved hvile with or without tissue loss, such as skin ulceration, diabetic ulcer or Koldbrand. CLI is estimated to occur in 1 to 2 percent of patients with symptomatic PAD. sup14

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%. sup12 Estimates show that 33% of CLI patients with an amputation will have a contralateral amputation within 3 to 5 years sup16. 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 amputation sup17. Early intervention with the right network is key to reduce the chances of amputation.

Livskvalitet

Mennesker med tab af lemmer på grund af CLI oplever betydeligt lavere sundhedsstatus, høje dødelighedsrater og øget risiko for hjerte-kar-sygdomme, fedme, led- og knogleproblemer, plus høje depressioner og følelsesmæssig nød.^22-27

Undersøgelser estimerer den 5-årige dødelighed for mennesker med en amputation på grund af PAD til at være mellem 50 % og 74 %, hvilket er højere end tyktarmskræft, brystkræft og koronararteriesygdom (CAD).^28-29