Panel issues landmark clinical guidelines for PAD.(Clinical Rounds)

Peripheral arterial disease affects 15-20 million Americans, but it is not being properly diagnosed or treated, according to the authors of new guidelines for the management of PAD.

"Severe peripheral arterial disease is essentially an overlooked medical emergency in the United States," said Dr. Alan T. Hirsch, chairman of the guidelines writing committee, in a briefing with reporters.

Cochair Dr. Ziv J. Haskal said a lack of focus on PAD--both by patients and physicians--has led to an average 4-month delay in diagnosing critical limb ischemia. Up to 80% of amputations may be due to that condition, and 60% may be preventable by earlier interventions, said Dr. Haskal, director of the vascular and interventional radiology division at New York-Presbyterian Hospital/Columbia University Medical Center in New York.

Though the panel cochairs stressed that PAD is underdiagnosed and undertreated, they hesitated to point fingers. "This isn't about looking back with blame. This is about looking forward," Dr. Hirsch said.

The committee called on physicians to routinely ask patients if they have PAD symptoms, and to adopt physical exam techniques to ferret out blockages in the legs, feet, aorta, kidneys, and intestines.

Guidelines on PAD have been published before, but none have had such broad backing, noted Dr. Hirsch, who is director of Abbott Northwestern Hospital's Vascular Center in Minneapolis.

The American Heart Association/American College of Cardiology Guidelines for the Management of Patients With Peripheral Arterial Disease is a product of the American Association for Vascular Surgery/Society for Vascular Surgery, the Society for Cardiovascular Angiography and Interventions, the Society of Interventional Radiology, the Society for Vascular Medicine and Biology, and the ACC/AHA Task Force on Practice Guidelines. They were endorsed by the American Association of Cardiovascular and Pulmonary Rehabilitation; the National Heart, Lung, and Blood Institute; the Society for Vascular Nursing; the TransAtlantic Inter-Society Consensus; and the Vascular Disease Foundation.