title: The Diagnosis and Treatment of Peripheral Arterial Vascular Disease.
abstract: BACKGROUND
  In peripheral arterial occlusive disease (PAOD), arterial stenosis or occlusion impairs perfusion in the territory of the distal portion of the aorta and the iliac and leg arteries. In Germany, the prevalence of PAOD rises with age, reaching 20% among persons over age 70.
  
  
  METHODS
  This guideline was prepared by a collaboration of 22 medical specialty societies and two patient self-help organizations on the basis of pertinent publications that were retrieved by a systematic search in PubMed for articles that appeared from 2008 to April 2014, with a subsequent update to May 2015.
  
  
  RESULTS
  294 articles were assessed, including 34 systematic reviews and 98 randomized controlled trials (RCTs). The diagnostic assessment of PAOD is based on physical examination, blood pressure at the ankles, and color-coded duplex ultrasonography (grade A recommendation). Other tomographic imaging methods can be used for suitable indications. The main elements of the treatment of PAOD are the control of cardiovascular risk factors and structured vascular exercise (grade A recommendation). Acetylsalicylic acid and statins are the main drugs for symptomatic PAOD (grade A recommendation). Patients with claudication and correlated structural findings can undergo an endo - vascular or open surgical procedure. Critical ischemia is an indication for arterial revascularization as soon as possible (grade A recommendation); this may be performed either by open surgery or by an endovascular procedure of one of the types that are now undergoing rapid development, or one of the crural treatment options. There is inadequate evidence concerning the optimal drug regimen after revascularization procedures.
  
  
  CONCLUSIONS
  The diagnostic assessment of PAOD is based on physical examination, measurement of the ankle-brachial index (ABI), and duplex ultrasonography. Acetylsalicylic acid and statins are indicated for patients with symptomatic PAOD. Endovascular procedures should be used if indicated. Randomized studies are needed to provide better evidence on many open questions in the treatment of PAOD.
authors.affiliation: Cardiovascular Department Ettlingen, Max Grundig Klinik Bühlerhöhe; Department of Diagnostic and Interventional Radiology, Klinikum Darmstadt GmbH; Department of Cardiology I - Medical Clinic for Cardiology, Angiology and Intensive Care, University Medical Center, Johannes Gutenberg University Mainz; Clinic for Vascular Surgery, Diakonissen-Stiftungs-Krankenhaus Speyer.
authors.forename: Holger
authors.initials: H
authors.lastname: Lawall
authors.forename: Peter
authors.initials: P
authors.lastname: Huppert
authors.forename: Christine
authors.initials: C
authors.lastname: Espinola-Klein
authors.forename: Gerhard
authors.initials: G
authors.lastname: Rümenapf
mesh_terms: D001157:Arterial Occlusive Diseases / Q000175:diagnosis / Q000628:therapy; D002318:Cardiovascular Diseases; D005858:Germany; D006801:Humans; D016491:Peripheral Vascular Diseases / Q000175:diagnosis / Q000628:therapy; D012307:Risk Factors