How should you evaluate an asymptomatic patient with a femoral or iliac artery bruit?

Manage risk factors aggressively

Although no studies show specifically that modifying risk factors in a patient with asymptomatic PAD affects long-term outcomes, aggressive risk factor management is recommended because PAD is highly associated with cerebrovascular and coronary artery disease.¹ No data suggest that treating asymptomatic PAD improves future limb pain or function.

Recommendations

The American College of Cardiology/American Heart Association 2005 Guidelines for the Management of Patients With Peripheral Arterial Disease² make the following recommendations for patients with asymptomatic lower extremity PAD:

• Identify patients with asymptomatic lower extremity PAD by examination or by measuring the ankle-brachial index so therapeutic interventions known to reduce the risk of myocardial infarction, stroke, and death can be offered (level of evidence [LOE]: B).
• Address smoking cessation, lipid lowering, and diabetes and hypertension treatment according to national guidelines (LOE: B).
• Consider antiplatelet therapy to reduce the risk of adverse cardiovascular ischemic events (LOE: C).

The United States Preventive Services Task Force recommends against routine screening for PAD (D recommendation).⁷

Acknowledgements

Special thanks to Felipe Navarro, MD.