From the Guidelines
For peripheral vascular disease (PVD) or peripheral arterial disease (PAD), patients should consult a vascular specialist, typically a vascular surgeon or interventional cardiologist, as recommended by the most recent guidelines 1.
Importance of Specialist Consultation
The decision to consult a specialist is crucial for the management of PAD, as it allows for comprehensive evaluation and treatment planning. Primary care physicians may make the initial diagnosis and manage mild cases, but referral to specialists is necessary for optimal care.
Role of Specialists
Vascular specialists, including vascular surgeons and interventional cardiologists, play a key role in the management of PAD. They can perform specialized testing, such as ankle-brachial index (ABI), duplex ultrasound, CT angiography, or MR angiography, to assess the extent and severity of the disease. These specialists can offer a range of treatments, from conservative management to more invasive procedures like angioplasty, stenting, or bypass surgery.
Multidisciplinary Approach
A multidisciplinary approach is essential for the management of PAD, as it ensures comprehensive care addressing both the vascular disease and its underlying causes. Endocrinologists may also be involved if diabetes is present, as it is a major risk factor for PAD. Early specialist consultation is particularly important for patients with severe symptoms, rapidly progressing disease, or critical limb ischemia to prevent complications like tissue loss or amputation.
Key Considerations
The 2024 ACC/AHA/AACVPR/APMA/ABC/SCAI/SVM/SVN/SVS/SIR/VESS guideline for the management of lower extremity peripheral artery disease 1 emphasizes the importance of detecting PAD in most patients through history, physical examination, and resting ankle-brachial index. The guideline also highlights the need to address health disparities in PAD and to provide effective medical therapies to prevent major adverse cardiovascular events and major adverse limb events.
Recommendations
Based on the most recent evidence 1, patients with PAD should consult a vascular specialist for comprehensive evaluation and treatment planning. The specialist can perform specialized testing and offer a range of treatments, from conservative management to more invasive procedures. A multidisciplinary approach is essential for optimal care, and early specialist consultation is crucial for preventing complications.
From the Research
Healthcare Professionals for Peripheral Vascular Disease (PVD)/Peripheral Arterial Disease (PAD) Consultation
To manage PVD/PAD effectively, it is essential to consult with the following healthcare professionals:
- Vascular surgeons: They specialize in surgical treatments for PVD/PAD, such as bypass surgery and angioplasty 2.
- Cardiologists: They can help manage cardiovascular risk factors associated with PVD/PAD, such as hypertension, diabetes, and high cholesterol 3, 4.
- Primary care physicians: They can provide ongoing care and monitor the patient's condition, as well as refer them to specialists as needed 5, 6.
- Interventional radiologists: They can perform minimally invasive procedures, such as angioplasty and stenting, to treat PVD/PAD 2.
Treatment and Management
Healthcare professionals may recommend the following treatments and management strategies for PVD/PAD:
- Antiplatelet therapy: Medications such as aspirin, clopidogrel, and cilostazol can help reduce the risk of blood clots and improve symptoms 4, 5, 6.
- Statins: These medications can help lower cholesterol levels and reduce the risk of cardiovascular events 3.
- Lifestyle modifications: Quitting smoking, exercising regularly, and eating a healthy diet can help manage PVD/PAD and reduce the risk of complications 3, 2.