Peripheral artery disease (PAD) affects millions of Americans, yet many patients remain undiagnosed until symptoms become severe. Current ACC/AHA guidelines reinforce the importance of earlier identification, risk assessment and appropriate vascular testing to help improve outcomes and reduce the risk of cardiovascular events.

Constantino S. Peña, M.D.

For referring physicians, these recommendations offer a valuable opportunity to identify high-risk patients sooner and intervene before PAD progresses to more advanced stages.

"Practice guidelines are intended to improve the quality of care and align with patients' interests, but they should always complement—not replace—clinical judgment," says Constantino S. Peña, M.D., system chief of interventional radiology at Baptist Health Miami Cardiac & Vascular Institute and a board-certified diagnostic and interventional radiologist with Baptist Health Heart & Vascular Care.

Recognizing PAD Beyond Classic Symptoms

One of the most important messages reflected in current PAD guidelines is that many patients with the disease are asymptomatic. Some may unknowingly limit their activity levels and never experience the classic symptoms of claudication, while others may have disease that has not yet progressed enough to produce noticeable symptoms.

Despite the absence of symptoms, these patients remain at increased risk for major adverse cardiovascular events, including heart attack, stroke and cardiovascular death.

The guidelines emphasize the importance of evaluating patients with established risk factors, including:

• Age 65 and older
• Diabetes
• Smoking history
• Hypertension
• Dyslipidemia
• Chronic kidney disease
• Family history of atherosclerotic disease
• Known cardiovascular disease affecting other vascular beds

For primary care physicians and specialists alike, identifying these risk factors may be the first step toward uncovering previously undiagnosed PAD.

A Comprehensive Evaluation Remains Essential

Current recommendations continue to stress the importance of a thorough history and physical examination. Physicians should assess for exertional leg pain, impaired walking function, ischemic rest pain, nonhealing wounds and changes in the lower extremities.

Physical examination should include pulse assessment as well as inspection of the legs and feet, particularly in patients with diabetes and other vascular risk factors.

When PAD is suspected, physiologic testing remains a cornerstone of diagnosis. The ankle-brachial index (ABI) continues to play an important role in evaluation, though clinicians should recognize its limitations in certain patient populations.

The Value of Comprehensive Vascular Testing

As understanding of PAD continues to evolve, there is growing recognition that no single test provides a complete picture of vascular health.

At Baptist Health Heart & Vascular Care, comprehensive noninvasive vascular testing may include ABI measurements, segmental pressure recordings, pulse volume recordings, toe-brachial index testing, exercise testing and vascular ultrasound when clinically indicated.

This comprehensive approach can help identify disease severity, clarify ambiguous findings and support more informed treatment decisions.

For patients with suspected PAD, timely diagnostic evaluation can help distinguish between asymptomatic disease, lifestyle-limiting claudication, chronic limb-threatening ischemia and acute limb ischemia—conditions that require different management strategies and levels of urgency.

Understanding When Referral Matters

While most patients with claudication will not progress to limb-threatening disease, prompt recognition of higher-risk presentations remains critical.

Patients experiencing ischemic rest pain, nonhealing wounds, tissue loss or signs of acute limb ischemia require urgent evaluation. Early referral can help facilitate coordinated care and potentially prevent avoidable complications, including amputation.

Current guidelines also reinforce an important principle: PAD is often a marker of systemic atherosclerotic disease. Identifying PAD should prompt a broader cardiovascular risk assessment and management strategy.

Supporting Earlier Detection and Coordinated Care

As awareness of PAD continues to grow, referring physicians play a critical role in helping patients access appropriate evaluation and treatment.

Through Baptist Health Heart & Vascular Care and the Center for Vascular Disease, physicians have access to advanced vascular diagnostics, multidisciplinary expertise and coordinated treatment pathways designed to support patients across the full spectrum of peripheral artery disease.

To refer a patient, visit BaptistHealth.net/HeartReferral.

To learn more about the Center for Vascular Disease and available vascular services, visit BaptistHealth.net/VascularDisease.