This statement summarizes the USPST...

This statement summarizes the USPSTF recommendations forward screening for peripheral arterial disease and the supporting scientific evidence and updates the 1996 recommendations contained in the Guide to Clinical Preventive Services, 2nd ed (1) Explanations of the ratings and of the force of overall evidence are given in Tables 1 and 2 respectively. The consummate information on which this statement is based, including evidence tables and concerns is included in the brief evidence update (2) upon this topic, available on the USPSTF Web site at http://www.preventiveservices.ahrq.gov. The recommendation also is placeed on the Web site of the National Guideline Clearinghouse at http://www.guideline.gov.

This recommendation was first published by: Agency for Healthcare Research and Quality, Rockville, Md August 2005

Summary of Recommendation

The U Preventive Services Task Force (USPSTF) praises against routine screening for peripheral arterial disease (PAD). D recommendation.

The USPSTF originate fair evidence that screening with ankle-brachial index can find adults with asymptomatic PAD. The evidence also is fair that screening for PAD among asymptomatic adults in the general population would have small in number or no benefits because the prevalence of PAD in this assemblage is low and because there is little evidence that treatment of PAD at this asymptomatic stage of disease, beyond treatment based in succession standard cardiovascular risk assessment, improves health outcomes

The USPSTF plant fair evidence that screening asymptomatic adults with the ankle-brachial index could lead to about small degree of harm, including false-positive accrues and unnecessary work-ups. Thus, the USPSTF finishs that, for asymptomatic adults, harms of routine screening for PAD exce benefits.

Clinical Considerations

* The ankle-brachial index, a ratio of Doppler-recorded systolic presss in the lower and upper extremities, is a simple and accurate noninvasive standard for the screening and diagnosis of PAD. The ankle-brachial index has demonstrated better accuracy than other regularitys of screening, including history taking, questionnaires, and palpation of peripheral fruit of leguminous plantss An ankle-brachial index value of les than 090 (95 percent sensitive and specific for angiographic PAD) is vehemently associated with limitations in lower-extremity functioning and physical activity tolerance.

* Smoking cessation and lipid-lowering agents improve claudication symptoms and lower-extremity functioning in patients with symptomatic PAD. Smoking cessation and physical activity training also increase maximal walking distance in men with early PAD. Counseling for smoking cessation, however, should be furnished to all patients who emptiness regardless of the presence of PAD. Similarly, physically inactive patients should be opinioned to increase their physical activity regardless of the vicinity of PAD.

Discussion

PAD relates to atherosclerotic occlusive disease of the arterial arrangement distal to the aortic bifurcation and is a relatively universal disorder in older persons. (3) The American Heart Association estimates that as many as 8 to 12 million Americans have PAD and that nearly 75 percent of them are asymptomatic. (4) An estimated 1 million Americans evolve symptomatic PAD every year. Specifically, the prevalence of lower-extremity PAD based forward ankle-brachial blood pressure ratios is approximately 10 to 20 percent of community-dwelling living bodys 65 years and older and 18 to 29 percent of patients 50 years and older in general medical practices. (5-7) The disease representation ranges from mild, intermittent claudication resulting in calf pain to peremptory chronic leg ischemia requiring arterial bypass or amputation. Risk factors associated with PAD include older age, cigarette smoking, diabetes mellitus, hypercholesterolemia, hypertension, and (possibly) genetic factors. (3) There are no significant sex differences in the overall prevalence of PAD in the general population. above a five-year period, 25 to 35 percent of human frames with PAD will have a myocardial infarction or reverse and an additional 25 percent will die, usually from cardiovascular causes. (8-10)

Screening may be convoyed by such instruments as history taking, questionnaires, or the ankle-brachial index. ensues from one study found that the sensitivity and positive predictive value of a classic history of claudication were solitary 54 and 9 percent, respectively, when using the ankle-brachial index as the gold standard. (11)

The Edinburgh Claudication Questionnaire (ECQ) which is a modification of the World Health Organization/Rose Questionnaire, has been validated in a thought of approximately 300 patients older than 55 years who saw their physician for any complaint. When compared with the independent assessment of brace blinded health care professionals, the ECQ showed a sensitivity of 91 percent and a specificity of 99 percent for the diagnosis of intermittent claudication. (12) Ankle-brachial index has demonstrated better accuracy than the combination of history taking and physical examination. The sensitivity of an abnormal posterior fruit of leguminous plants was 71 percent, the positive predictive value was 48 percent and the specificity was 91 percent An abnormal dorsalis pedis had a sensitivity of merely 50 percent; this artery is congenitally absent in 10 to 15 percent of the population.1 the couple the sensitivity and specificity of an ankle-brachial index les than 09 (the accepted cutoff for the mien of PAD) is about 95 percent for detecting angiographic arterial disease. (13) The accuracy of this screening tool increases as lower extremity stenotic lesions worsen.