PAD can be diagnosed noninvasively using the ABI. The ABI is the ratio of blood pressure measurements in the foot and arm; values <0.9 are considered abnormal. However, the U.S. Preventive Services Task Force (USPSTF) does not advocate PAD screening due to insufficient evidence for estimating the relative benefits and harms of ABI testing (I statement).Nonetheless, the American College of Cardiology Foundation/American Heart Association (ACCF/AHA) practice guidelines recommend measuring ABI in those at risk, as detailed in the box below, in order to offer therapeutic interventions to reduce the risk of cardiovascular events.

Learn to use the ABI, which is reliable, reproducible, and easy to perform in the office. Although the sensitivity of an abnormal ABI is low (15% to 20%), the specificity is 99%, and the test has high positive and negative predictive values (both >80%). Clinicians or office staff can easily measure systolic blood pressure in the arms using a sphygmomanometer and the pedal pulses using Doppler ultrasound. These values can be entered into calculators available at selected website.

For patients with PAD and intermittent claudication, the ACCF/AHA guidelines strongly recommend supervised exercise programs as the initial treatment. Randomized clinical trials have shown significantly increased pain-free walking distances with supervised exercise programs compared to nonsupervised programs. Other recommendations for managing PAD include: tobacco cessation; treatment of hyperlipidemia; optimal control of diabetes and hypertension; use of antiplatelet agents; meticulous foot care and well-fitting shoes, particularly for diabetic patients; and, in selected cases, revascularization.

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