First of all, PAD screening has been recommended by international guidelines as follows:
- For people with known vascular disease risk factors, such as diabetes, high-risk ethnicity, smoking history, an abnormal pulse, hypertension, elevated cholesterol, existing cardiovascular disease or a history of vascular surgery.
- There is current recommendation not to perform PAD screening in asymptomatic people using the ankle-brachial index (ABI). However doppler, toe pressure and toe-brachial index (TBI) screening are useful.
- For people over 65 or 70 years of age.
- Frequency of screening depends on risk level and clinical imperatives but is advised at least annually. People with diabetes and neuropathy are recommended to have a neurovascular screening every three to six months, or every one to three months if they have a history of foot ulcers.
Why is PAD important?
Because “Life is Why”. Identifying PAD can make life and limb-saving differences to people’s lives, since podiatrists care for people with various levels of cardiovascular disease (CVD).
Although some people are symptomatic, in which case their disease has usually been diagnosed, an important proportion of people with CVD are asymptomatic, and these people often remain undiagnosed.
Why does PAD so often go undiagnosed?
- Historically, classification of PAD relied on visual signs and symptoms, especially intermittent claudication and loss of pulses. However 66% of people with PAD have palpable pulses.
- PAD is symptomatic in only about 25% of people with the disease.
- You can't actually see PAD unless there is tissue damage that occurs in advanced disease.
- People can have feet that look and feel absolutely normal, yet have clinically significant PAD with operable lower-limb stenoses.
- Only a minor percentage of people with PAD have claudication - 11% in an elderly population.
We can potentially save lives
Ischaemic heart disease (IHD) and stroke are the most common manifestations of PAD, and these were the top two causes of death in 2019. Prior to the COVID pandemic, IHD was responsible for the largest increase in deaths over the last two decades.
A majority of these people with IHD will be developing asymptomatic vascular disease in their peripheral arteries, with a strong predilection for the vessels in the lower limb, before they are diagnosed with cardiac or brain vessel disease.
Most importantly, up to one quarter of people who die from a heart attack or stroke had no known CVD risk factors prior to their death and people with no previously known risk factors have higher fatality rates in the days after their heart attacks.