Screening for peripheral arterial disease

Peripheral arterial disease (PAD) is caused by fatty deposits on the walls of the arteries (or atherosclerosis) that leads to narrowing of the arteries (or stenosis) and obstructions in the major vessels supplying the lower legs. PAD can cause discomfort or pain in the lower legs when walking. People with PAD have an increased risk of death, heart and cerebrovascular disease and often receive treatment to manage their cardiac risk. They suffer from significant functional limitations in their daily activities, and the most severely affected are at risk of limb loss. Many people with PAD do not have any symptoms. Only some people have discomfort or pain in the lower legs when walking, so PAD often goes undetected. One possible way to identify this disease is to screen the population at increased risk of PAD. It is important to determine the effectiveness of screening in preventing heart and cerebrovascular diseases or further progression of PAD.

This review found no randomised controlled trial evidence on screening for PAD. High quality research is required to help healthcare providers decide whether screening for PAD in asymptomatic and undiagnosed individuals is effective in terms of reduction of all-cause mortality, cardiovascular events (for example myocardial infarction and stroke), morbidity from PAD (intermittent claudication, amputation, reduced walking distance) and improvement in quality of life.

Authors' conclusions: 

Unfortunately, no randomised controlled trial data are available regarding screening for PAD. Therefore, we are unable to determine the effects of screening for PAD in order to guide decision making by healthcare providers and planners. High quality randomised controlled trials evaluating the effectiveness of screening for PAD in asymptomatic and undiagnosed individuals in terms of reduction of all-cause mortality, cardiovascular events (for example myocardial infarction and stroke), morbidity from PAD (intermittent claudication, amputation, reduced walking distance) and improvement in quality of life are needed.

Read the full abstract...
Background: 

In the general population, up to 10% of people younger than 70 years and 15% to 20% of people older than 70 years have peripheral arterial disease (PAD). Symptomatic and asymptomatic PAD has an estimated prevalence of 13% in the over 50 years age group. However, asymptomatic PAD can account for up to 75% of PAD patients and only 10% of PAD patients have typical intermittent claudication. People with PAD are at an increased risk of death, heart and cerebrovascular disease and are recommended to receive treatment to manage their cardiac risk. They suffer from significant functional limitations in their daily activities and the most severely affected are at risk of limb loss. Many people with PAD do not have any symptoms. Only some people have discomfort or pain in the lower legs when walking, so PAD often goes undetected. Given the high incidence of asymptomatic and undiagnosed PAD, it is important to determine the effectiveness of a screening intervention in preventing cardiovascular adverse outcomes, both fatal and non-fatal.

Objectives: 

To determine the effectiveness of screening for PAD in asymptomatic and undiagnosed individuals in terms of reduction of all-cause mortality, cardiovascular events (for example myocardial infarction and stroke), morbidity from PAD (intermittent claudication, amputation, reduced walking distance) and improvement in quality of life.

Search strategy: 

The Cochrane Peripheral Vascular Diseases Group Trials Search Co-ordinator searched the Specialised Register (last searched November 2013) and CENTRAL (2013, Issue 10).

Selection criteria: 

All published and unpublished randomised controlled trials (RCTs) of screening for PAD were sought without language restriction.

Data collection and analysis: 

Studies identified for potential inclusion in the review were independently assessed by both review authors. We planned to conduct data collection and analysis in accordance with the Cochrane Handbook for Systematic Review of Interventions.

Main results: 

No RCTs were identified that met the inclusion criteria.

Share/Save