title: Peripheral arterial disease - diagnosis and management in general practice.
abstract: BACKGROUND
  Peripheral arterial disease (PAD) is a manifestation of systemic atherosclerosis. It affects 10-15% of the general population, and is often asymptomatic; leading to under-diagnosis and under-treatment. Atherosclerotic risk factors are often not intensively managed in PAD patients.
  
  
  OBJECTIVE
  To summarise the information around the diagnosis and management of PAD in the general practice setting.
  
  
  CONCLUSIONS
  Careful history, clinical examination, and measurement of ankle-brachial index remain the initial means of diagnosing PAD. More detailed anatomic information from duplex imaging, computed tomography angiography and magnetic resonance angiography, is usually unnecessary unless endovascular or surgical intervention is being considered, or if abdominal aortic aneurysm or popliteal aneurysm need to be excluded. Management is focused on lifestyle modification, including smoking cessation and exercise; medical management of atherosclerotic risk factors, including antiplatelet agents, statins, antihypertensive therapy; and agents to improve walking distance, such as cilostazol and ramipril. Endovascular or surgical interventions are usually considered for lifestyle limiting intermittent claudication not responding to conservative therapies, and for critical limb ischaemia.
authors.affiliation: Menzies Research Institute Tasmania, University of Tasmania, Tasmania. bich.au@utas.edu.au
authors.forename: Thuy Bich
authors.initials: TB
authors.lastname: Au
authors.forename: Jonathan
authors.initials: J
authors.lastname: Golledge
authors.forename: Philip J
authors.initials: PJ
authors.lastname: Walker
authors.forename: Kate
authors.initials: K
authors.lastname: Haigh
authors.forename: Mark
authors.initials: M
authors.lastname: Nelson
mesh_terms: D055109:Ankle Brachial Index; D001315:Australia; D002317:Cardiovascular Agents / Q000627:therapeutic use; D003131:Combined Modality Therapy; D004035:Diet Therapy; D005081:Exercise Therapy; D058006:General Practice; D006801:Humans; D018810:Magnetic Resonance Angiography; D008487:Medical History Taking; D058729:Peripheral Arterial Disease / Q000175:diagnosis / Q000209:etiology / Q000628:therapy; D010808:Physical Examination; D012307:Risk Factors; D014057:Tomography, X-Ray Computed; D014656:Vascular Surgical Procedures
chemical_list: D002317:Cardiovascular Agents