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ClearRounds Health · Cardiology · Quick Reference

Peripheral Vascular Disease

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Vascular & ThromboembolicIntermediateIn progressOne-page PDF

PAD symptoms, ABI, medical therapy, exercise therapy, CLI signs, imaging, and revascularization referral.

Last reviewed

Pending initial clinical review

Sources / guidelines to verify

  • 2024 ACC/AHA Lower Extremity PAD Guideline
Disclaimer: Educational reference only. Not a substitute for clinician judgment, local protocols, or current guideline review.

One-page reference

Draft content pending the site owner’s clinical review. Verify against the sources above and local protocol before clinical use.

1

What it is / why it matters

  • Atherosclerotic lower-extremity PAD — a marker of systemic ASCVD with high MI/stroke risk.
  • Spectrum: asymptomatic → claudication → chronic limb-threatening ischemia (CLTI).
2

Key diagnostic clues

  • Claudication: reproducible calf/thigh pain with walking, relieved by rest.
  • Rest pain, non-healing wounds, diminished pulses, hair loss, dependent rubor.
  • ABI ≤0.90 is diagnostic; ABI >1.40 is non-compressible → use toe-brachial index.
3

Initial workup

  • Resting ABI (TBI if non-compressible).
  • Anatomic imaging (duplex / CTA / MRA) when revascularization is considered.
  • Assess and treat all cardiovascular risk factors.
4

Management framework

Risk reduction (every patient)

  • High-intensity statin (LDL <55)
  • Antiplatelet (aspirin or clopidogrel)
  • Smoking cessation; BP and diabetes control

Dual-pathway (Class 1)

  • Rivaroxaban 2.5 mg BID + aspirin 81 mg for symptomatic PAD / post-revascularization to reduce MACE and MALE

Symptom / limb therapy

  • Supervised exercise therapy (first-line for claudication)
  • Cilostazol for claudication symptoms
  • Revascularization for lifestyle-limiting refractory claudication or CLTI
5

Red flags / escalate now

  • CLTI (rest pain, ulcers, gangrene) → urgent vascular referral (limb threat).
  • Acute limb ischemia — the 6 P’s (pain, pallor, pulselessness, paresthesia, poikilothermia, paralysis) → EMERGENT.
6

Follow-up / monitoring

  • ABI, symptoms, wound checks, risk-factor goals, and medication adherence.
7

Clinic pearls

  • PAD is a coronary risk equivalent — be aggressive with secondary prevention.
  • Supervised exercise rivals revascularization for claudication.
  • Acute limb ischemia is a surgical emergency — act fast.

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ClearRounds Health · Cardiology — Peripheral Vascular Disease Quick Reference · Last reviewed: Pending initial clinical review · Educational reference only. Not a substitute for clinician judgment, local protocols, or current guideline review.