Key Patient Messages: 2024 AHA/ACC Guideline on the Management of Lower Extremity Peripheral Artery Disease

Published: May 14, 2024

Peripheral Artery Disease (PAD) can occur with or without symptoms.

One common symptom is claudication. This is when there is pain, fatigue, cramping, aching, or other discomfort in the legs, buttock, hip, foot, or anywhere on the lower limb while walking or exercising that is relieved by rest after about 10 minutes. It’s important not to dismiss this symptom and to let a clinician know about this type of pain.

However, many people don’t know they have PAD. Knowing the risk factors for developing this health condition can help improve care and symptoms.

Those risks are:
- Have one or more of the following health conditions: narrowing of the arteries, diabetes, high blood pressure, high cholesterol, and chronic kidney disease.
- Age: 65 and older or 50 - 64 with any of the following risk factors
- Women: particularly if 70 and older
- Smoking
- Family history of PAD

Patients with PAD have an increased risk of having a stroke, heart attack, limb amputation, impaired quality of life, and death. For patients that have had surgery, procedures, or other medical treatment for PAD, long- term follow up care is important to manage these risks.

Foot care is very important to prevent PAD or to diagnose the severity of the disease.

Having regular foot exams and working with a podiatrist to find the best shoe to prevent wounds from forming can help. It can be difficult for minor wounds to heal with PAD which can lead to infection, tissue damage and require amputation in severe cases.
Foot exams for PAD are painless and can include measuring blood pressure through the Ankle Brachial Index (ABI) or taking images of the arteries.

Treating PAD can involve a care team with many clinicians and health professionals. Learning who to talk to about different health condition symptoms can make it easier to manage care.

Engaging in shared-decision making with the PAD care team is very important. In this process the patient shares their goals and preferences for treatment. The clinician can then carefully explain treatment options and help the patient weigh the treatment risks with the impact to the patient’s quality of life.

Clinicians may recommend drugs, procedures or surgeries to treat PAD. This could include amputation depending on the severity of the disease.

Antiplatelet and antithrombotic drugs to help prevent blood clots.
Lipid-lowering drugs to prevent a blockage in the artery.
Drugs to treat other health conditions.
Procedures called revascularization to restore blood flow to parts of the limb when the blood flow from the heart is limited or blocked.

There are great benefits to engaging in structured exercise programs, even with PAD. It’s important for patients to ask their clinician what type of activities to avoid, and what type of activities are encouraged.

Eat a healthy diet
Quit smoking, for patients that smoke look for ways to stop smoking. It often takes a few tries before someone can quit, so don’t be discouraged if the first time is not successful.
Walk or find ways to move every day.
Receive annual flu shots and other recommended vaccines.

Citation

Gornik HL, Aronow HD, Goodney PP, Arya S, Brewster LP, Byrd L, Chandra V, Drachman DE, Eaves JM, Ehrman JK, Evans JN, Getchius TSD, Gutiérrez JA, Hawkins BM, Hess CN, Ho KJ, Jones WS, Kim ESH, Kinlay S, Kirksey L, Kohlman-Trigoboff D, Long CA, Pollak AW, Sabri SS, Sadwin LB, Secemsky EA, Serhal M, Shishehbor MH, Treat-Jacobson D, Wilkins LR. 2024 ACC/AHA/AACVPR/APMA/ABC/SCAI/SVM/SVN/SVS/SIR/VESS guideline for the management of lower extremity peripheral artery disease: a report of the American College of Cardiology/AmericanHeart Association Joint Committee on Clinical Practice Guidelines. Circulation. Published online May 14, 2024. doi:10.1161/CIR.0000000000001251