Recognizing Peripheral Arterial Disease: A Window of Opportunity to Reduce Vascular Events

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INTRODUCTION

Patients with peripheral arterial disease (PAD) have a 15-fold greater risk of death due to cardiovascular causes than patients without evidence of PAD. Although prevalence estimates vary depending on the definition used, PAD is underdiagnosed, and a significant number of patients with asymptomatic PAD are at risk for complications. Furthermore, only a small percentage of patients with PAD receive any treatment.

The aim of this CME series is to educate physicians on (1) clinical aspects of PAD, including its prevalence; (2) associated cardiovascular risks; (3) diagnostic criteria and strategies for identifying high-risk patients; (4) noninvasive diagnostic methods; and (5) medical, surgical, and endovascular treatments. Each course provides a maximum of 0.5 AMA PRA Category 1 Credit™.

Please note that the courses are accredited only for physicians (MD, DO, or equivalent). All other participants receive a certificate of completion.

AVAILABLE COURSES

	DESCRIPTION Julio S—, a 56-year-old Hispanic man who smokes, presents with leg pain upon walking. The pain has recently increased in intensity, reducing his quality of life. Julio first noticed "tightness" in his left leg approximately 6 months ago. He now has pain in his left calf, thigh, and buttock when walking the equivalent of 2 blocks. The pain disappears if he sits down to rest.

DESCRIPTION
Deborah M— is a 54-year-old white woman with a history of dyslipidemia. During her annual physical, she notes that she has recently decreased her level of physical activity because of fatigue. Her lipid levels have been treated with diet, exercise, and atorvastatin. When questioned about her current level of exercise, she states that she and her husband have decreased their number of long hikes and bird-watching trips because she “gets tired easily.”

DESCRIPTION
Jane R— is a 60-year-old white woman with diabetes who presents because of discomfort in her left calf while walking. The calf discomfort is fairly reproducible and comes on at even shorter distances when she walks uphill. When questioned about her level of physical activity, Jane notes that her family members avoid walking with her because she walks slowly, and she complains of needing to rest frequently.

DESCRIPTION
The patient reports having first noticed an aching pain, which he describes as a “charley horse,” localized to his left calf when walking about 8 months ago. Initially, the pain occurred after he had walked for about 12 minutes, but for the past 2 months, it appears after he walks for only 7-8 minutes. The pain is bad enough that the patient must stop to rest for a few minutes until it resolves. He denies having pain when standing, sitting, or lying down.