The importance of early identification of atherosclerotic vascular disease

Abstract

Peripheral Arterial Disease [PAD] is a significant public-health problem. It has been estimated that only approximately 25% of patients living with PAD receive treatment since most people are not aware that they are living with this condition. Despite the lack of symptoms such patients still share the same prognosis as symptomatic patients showing a risk profile comparable to patients with symptomatic lower extremity PAD or with chronic heart disease. It is imperative that this condition is diagnosed as early as possible in order to avoid devastating further complications including atherosclerotic cardiovascular complications. The aim of this chapter is to report studies evaluating the occurrence and diagnosis of peripheral arterial disease using different non-invasive modalities in specific diverse populations namely patients living with Type 2 diabetes mellitus, smokers and non-smokers. A further aim is to compare these modalities in order to determine whether a correlation between them exists. Although large clinical randomized studies on arterial disease are limited, this chapter provides evidence from recently published studies on the importance of using different non-invasive modalities when assessing patients with arterial disease and when results do not concur, further extensive evaluations should be performed. These findings reported in this chapter have important implications for both clinical practice and future research. The findings from our present studies suggest that use of ABPI alone in patients with Type 2 diabetes mellitus or smokers is likely to yield high false negative results. We recommend that peripheral arterial perfusion in patients with diabetes or smokers should be assessed utilizing ABPIs, Doppler waveforms and toe pressures and toe brachial pressure indices. When the findings from these modalities do not correlate these patients should be monitored or further evaluated accordingly. One possible alternative when inconsistencies occur between modalities could include further physiological testing including duplex scanning, high resolution CT and magnetic resonance imaging to establish whether PAD is actually present.