Practice Points

• Approximately 12% of adults in Newfoundland and Labrador have Peripheral Artery Disease (PAD).
• Usually, patients with PAD DO NOT need a test or revascularization procedure.
• There are simple and safe ways to improve PAD symptoms through home management.
• Choosing Wisely Canada guideline: Do not suggest a test that will not change the patient’s clinical course.
• Do peripheral vascular testing in those who could potentially benefit from a revascularization procedure.

Who Needs a Test?

Refer patients for peripheral vascular testing if they have any of the following:

• Rest pain: Pain in feet, especially when legs are elevated in bed.
• Extremity ulcer: Sores on toes or feet that won’t heal.
• Gangrene: Toe that looks blue or black and may hurt.
• Severe Claudication: Leg pain during exercise severe enough to limit lifestyle or ability to work.

Who Needs a Test and Who Doesn’t?

Only refer patients with “Good Indicators” for PAD testing:

Good Indicators

• Rest Pain (pain in feet, especially when legs are elevated in bed)
• Tissue Loss (ulcers/sores on the feet that will not heal or a toe that is blue or black and may hurt)
• Severe Claudication (leg pain while walking severe enough to limit lifestyle or work)

Poor Indicators

• Mild claudication (mild leg pain during exercise that stops when at rest)
• Leg cramps
• Raynaud’s
• Digital cyanosis
• Absent peripheral pulses
• Family history with no symptoms

How Can We Improve?

Our objective is to test patients with symptoms of vascular disease that may need revascularization quickly, and not test patients unless they have symptoms indicative of disease requiring surgical intervention.

Unnecessary tests increase wait times for all patients.

What You Can Do…

For patients with symptoms of mild to moderate PAD, a home management plan is the best way to manage and reduce symptoms. Discuss lifestyle options with these patients and provide them with a pamphlet.

Home management plans may include:

• Quitting smoking
• Regular exercise (walk daily)
• Aspirin and/or Plavix
• Diabetic management
• Blood Pressure control (with ACE)
• Proper foot care
• Cholesterol control (with Statin)