6
Diagnosis
Table 2. Patients at Increased Risk of PAD
Age ≥65 y
Age 50–64 y, with risk factors for atherosclerosis (e.g., diabetes mellitus, history of
smoking, hyperlipidemia, hypertension) or family history of PAD
Age <50 y, with diabetes mellitus and 1 additional risk factor for atherosclerosis
Individuals with known atherosclerotic disease in another vascular bed (e.g., coronary,
carotid, subclavian, renal, mesenteric artery stenosis, or abdominal aortic aneurysm [AAA])
Table 3. History and/or Physical Examination Findings
Suggestive of PAD
History
Claudication
Other non–joint-related exertional lower extremity symptoms (not typical of
claudication)
Impaired walking function
Ischemic rest pain
Physical Examination
Abnormal lower extremity pulse examination
Vascular bruit
Nonhealing lower extremity wound
Lower extremity gangrene
Other suggestive lower extremity physical findings (e.g., elevation pallor/dependent
rubor)
Clinical Assessment for PAD
Table 4. History and Physical Examination
COR LOE
Recommendations
I B-NR Patients at increased risk of PAD (Table 2) should undergo a
comprehensive medical history and a review of symptoms to
assess for exertional leg symptoms, including claudication or other
walking impairment, ischemic rest pain, and nonhealing wounds.
I B-NR Patients at increased risk of PAD (Table 2) should undergo vascular
examination, including palpation of lower extremity pulses (i.e.,
femoral, popliteal, dorsalis pedis, and posterior tibial), auscultation
for femoral bruits, and inspection of the legs and feet.
I B-NR Patients with PAD should undergo noninvasive blood pressure
measurement in both arms at least once during the initial
assessment.
