American College of Physicians: Internal Medicine — Doctors for Adults ®

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Peripheral arterial disease

Prevention and Screening

Diagnosis

Therapy

Hospitalization

Management consultation

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Patient education and follow-up

Counsel patients about the natural progression of PAD, and reassure them that systemic atherosclerosis can be significantly stabilized if patients comply with risk factor and medical therapy. Most PAD will not progress to a point requiring an intervention, and modification of risky behaviors—including smoking, exercise and diet—can greatly reduce the disease’s progression.

Recommend periodic follow-up to evaluate medical control of hypertension, lipids, diet and tobacco use. Regularly check blood pressure, lipid levels, creatinine and fasting blood glucose in this high risk population.

Patients who undergo surgical arterial reconstruction will need lifelong follow-up by physical exam, ABI, and duplex ultrasound bypass graft interrogation. Postsurgical graft stenosis is the leading cause of long-term graft failures. Detecting subclinical graft stenosis can allow intervention before graft thrombosis occurs. Bypass salvage is usually unsuccessful after thrombosis, and thromboytics are often not efficacious.


Patients who undergo surgical arterial reconstruction will need lifelong follow-up.

Little data exist regarding follow-up for patients who have had an endovascular revascularization, though routine follow up for recurrent PAD symptoms is indicated at 6 months to yearly intervals.

Wound care after an intervention depends on the severity of the wound, complications and the patient’s support systems. Wounds and complications are common after peripheral surgical interventions, and wound healing may take weeks to months and require further surgeries.

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