title: A systematic review for the screening for peripheral arterial disease in asymptomatic patients.
abstract: BACKGROUND
  Peripheral arterial disease (PAD) is common and associated with significant morbidity and mortality. PAD can be detected through a noninvasive measurement of the ankle-brachial index (ABI).
  
  
  METHODS
  We conducted a systematic review of several electronic bibliographic databases for studies that evaluated ABI as a screening test for PAD in asymptomatic individuals. We conducted random-effects meta-analysis, reporting pooled hazard ratios (HRs) when appropriate.
  
  
  RESULTS
  We included 40 individual studies, 2 systematic reviews, and 1 individual-patient data meta-analysis. We found no studies comparing ABI screening with no screening in terms of patient-important outcomes (mortality, amputations). The yield of PAD screening averaged 17% (range, 1%-42%) and was 1% to 4% in lower risk populations. Patients with PAD had higher adjusted risk of all-cause mortality (HR, 2.99; 95% confidence interval, 2.16-4.12) and of cardiovascular mortality (HR, 2.35; 95% confidence interval, 1.91-2.89). Data on benefits, harms, and cost-effectiveness of screening were limited; however, ABI screening was associated with additional prognostic information and risk stratification for heart disease. The overall quality of evidence supporting screening was low.
  
  
  CONCLUSIONS
  The current available evidence demonstrates that PAD is common in patients with multiple cardiovascular risk factors and is associated with significant morbidity and mortality, but it does not support the benefit of routine ABI screening.
authors.affiliation: Knowledge and Evaluation Research Unit, Department of Medicine, Mayo Clinic, Rochester, Minn; Division of Preventive, Occupational and Aerospace Medicine, Mayo Clinic, Rochester, Minn.
authors.forename: Fares
authors.initials: F
authors.lastname: Alahdab
authors.affiliation: Knowledge and Evaluation Research Unit, Department of Medicine, Mayo Clinic, Rochester, Minn; Division of General Internal Medicine, Harbor UCLA Medical Center, Torrance, Calif.
authors.forename: Amy T
authors.initials: AT
authors.lastname: Wang
authors.affiliation: Knowledge and Evaluation Research Unit, Department of Medicine, Mayo Clinic, Rochester, Minn; Division of Preventive, Occupational and Aerospace Medicine, Mayo Clinic, Rochester, Minn.
authors.forename: Tarig A
authors.initials: TA
authors.lastname: Elraiyah
authors.affiliation: Division of Vascular Surgery, University of Oklahoma, Tulsa, Okla.
authors.forename: Rafael D
authors.initials: RD
authors.lastname: Malgor
authors.affiliation: Minneapolis Heart Institute Foundation at Abbott Northwestern Hospital, Vascular and Endovascular Surgery, Minneapolis, Minn.
authors.forename: Adnan Z
authors.initials: AZ
authors.lastname: Rizvi
authors.affiliation: Knowledge and Evaluation Research Unit, Department of Medicine, Mayo Clinic, Rochester, Minn.
authors.forename: Melanie A
authors.initials: MA
authors.lastname: Lane
authors.affiliation: Knowledge and Evaluation Research Unit, Department of Medicine, Mayo Clinic, Rochester, Minn; Mayo Clinic Libraries, Mayo Clinic, Rochester, Minn.
authors.forename: Larry J
authors.initials: LJ
authors.lastname: Prokop
authors.affiliation: Knowledge and Evaluation Research Unit, Department of Medicine, Mayo Clinic, Rochester, Minn; Division of Endocrinology and Diabetes, Mayo Clinic, Rochester, Minn.
authors.forename: Victor M
authors.initials: VM
authors.lastname: Montori
authors.affiliation: Division of Vascular and Endovascular Surgery, University of California San Francisco, San Francisco, Calif.
authors.forename: Michael S
authors.initials: MS
authors.lastname: Conte
authors.affiliation: Knowledge and Evaluation Research Unit, Department of Medicine, Mayo Clinic, Rochester, Minn; Division of Preventive, Occupational and Aerospace Medicine, Mayo Clinic, Rochester, Minn. Electronic address: murad.mohammad@mayo.edu.
authors.forename: Mohammad Hassan
authors.initials: MH
authors.lastname: Murad
mesh_terms: D055109:Ankle Brachial Index; D058070:Asymptomatic Diseases; D006801:Humans; D035002:Lower Extremity / Q000098:blood supply*; D058729:Peripheral Arterial Disease / Q000175:diagnosis* / Q000401:mortality / Q000503:physiopathology; D011237:Predictive Value of Tests; D011379:Prognosis; D012307:Risk Factors