The Indian Consensus Statement for the Management of Lower Extremity Peripheral Artery Disease

Abstract

Peripheral arterial disease (PAD) is one of the underdiagnosed and undertreated vascular diseases despite its significant burden in India. In India, the etiological aspects, diagnostic approaches, treatment modalities, and other preventive measures probably vary in different regions. Therefore, this consensus was developed that provides a unified approach for physicians to effectively diagnose and manage PAD in India. In this consensus, we identify that the prevalence of PAD varies from 5% to 25% in Indian setting. Both atherosclerotic and non-atherosclerotic risk factors may underlie PAD. Asymptomatic PAD remains the most common presentation of the disease. The detailed clinical history, physical changes in the lower leg skin, and examination of peripheral pulses can provide clues to the diagnosis. Ankle-brachial index and Duplex ultrasound are advised as the initial choice of diagnostic measures. Besides control of risk factors such as hypertension, diabetes, dyslipidemia, and smoking, pharmacological treatment with anti-platelet and antithrombotic drugs is advised. By efficacy, ticagrelor is considered equivalent to clopidogrel and cilostazol is advised in intermittent claudication. In the revascularization of tibio-pedal lesions, endovascular therapy is effective and arterial bypass with vein graft may be needed in difficult and extensive revascularization scenarios. In these lesions, prosthetic grafts must be avoided. Diabetic foot ulcer management is challenging as foot care among diabetics is poor. In limb, salvation should always be a priority with avoidance of amputation if possible. Stem cell therapy has been successful in PAD which can be advised to “no-option” patients to prevent amputation. Physicians should undertake effective screening of PAD and be considered “PAD Clinics” in India.