PAD

Question 1

What does PAD stand for?

Answer 1

Peripheral artery disease.

Question 2

PAD is a form of what broader disease category?

Answer 2

Atherosclerotic cardiovascular disease (ASCVD).

Question 3

In PAD, what does “peripheral” mean?

Answer 3

Non-coronary and non-cerebrovascular arteries.

Question 4

Where is PAD most commonly found?

Answer 4

The lower extremities.

Question 5

About how many people worldwide have PAD?

Answer 5

About 230 million.

Question 6

What percentage of PAD cases are limb-threatening?

Answer 6

About 11%.

Question 7

What does CLTI stand for?

Answer 7

Chronic limb-threatening ischemia.

Question 8

What are major PAD risk factors?

Answer 8

Age over 65, male sex, hypertension, dyslipidemia, diabetes, CKD, CAD, stroke, erectile dysfunction, and current or former tobacco smoking.

Question 9

What happens to PAD risk with one risk factor?

Answer 9

About a 50% increase.

Question 10

What happens to PAD risk with 3 or more risk factors?

Answer 10

About a 10-fold increase.

Question 11

What is the basic pathophysiology of PAD?

Answer 11

Plaque builds up in medium- and large-sized arteries, reducing blood flow and oxygen supply.

Question 12

Which arteries are commonly affected in PAD?

Answer 12

Iliac, femoral, popliteal, and tibial arteries.

Question 13

What are the 4 broad PAD clinical presentations?

Answer 13

Asymptomatic PAD, chronic symptomatic PAD, chronic limb-threatening ischemia (CLTI), and acute limb ischemia (ALI).

Question 14

Why might a patient with PAD be asymptomatic before diagnosis?

Answer 14

Functional limitations or a sedentary lifestyle may mask symptoms.

Question 15

What is the hallmark symptom of chronic symptomatic PAD?

Answer 15

Intermittent claudication.

Question 16

How is intermittent claudication described?

Answer 16

Discomfort, pain, aching, cramping, fatigue, tingling, burning, or numbness with exertion that improves within 10 minutes of rest.

Question 17

What are atypical symptoms of chronic symptomatic PAD?

Answer 17

Pain at rest that worsens with exertion and erectile dysfunction.

Question 18

What are key features of CLTI?

Answer 18

Ischemic pain at rest, forefoot pain, pain worse with elevation, nonhealing wounds or ulcers, and gangrene.

Question 19

Which PAD presentation causes most amputations related to PAD?

Answer 19

Chronic limb-threatening ischemia (CLTI).

Question 20

What is acute limb ischemia (ALI)?

Answer 20

A sudden decrease in arterial perfusion to the limb.

Question 21

What are signs of ALI?

Answer 21

Discoloration or pallor, pulselessness, poikilothermia (cold limb), paresthesia, and paralysis.

Question 22

Are there specific lab tests for PAD diagnosis?

Answer 22

No, there are no specific lab tests.

Question 23

What physical exam findings are important in PAD?

Answer 23

Pedal pulses, bruits, and wounds or ulcers.

Question 24

What does ABI stand for?

Answer 24

Ankle-brachial index.

Question 25

What is ABI?

Answer 25

The ratio of ankle blood pressure to arm blood pressure.

Question 26

What ABI confirms PAD?

Answer 26

Less than 0.9.

Question 27

What should be done if PAD symptoms are present but ABI is normal?

Answer 27

Treadmill testing.

Question 28

What imaging can be used for additional PAD assessment?

Answer 28

Ultrasound, CT angiography (CTA), or MR angiography (MRA).

Question 29

What social factors can worsen PAD outcomes?

Answer 29

Chronic stress, lower-quality education and health literacy, lower income, poor housing, limited access to food/exercise, inadequate insurance, poor access to care, and job/workplace impacts. The slide summarizes these under social determinants of health.

Question 30

What “risk amplifiers” should be assessed in PAD?

Answer 30

Diabetes, CKD/ESRD, polyvascular disease, microvascular disease, and depression.

Question 31

Why is smoking cessation especially important in PAD?

Answer 31

Smoking increases rehospitalization and revascularization risk, and 5-year mortality with smoking plus PAD is about 40–50%.

Question 32

What smoking cessation aids are listed in the slides?

Answer 32

Nicotine replacement, bupropion, and varenicline.

Question 33

What nonpharmacologic interventions are recommended for PAD?

Answer 33

Supervised exercise therapy, community-based exercise programs, and behavioral change-based programs.

Question 34

When are revascularization procedures used in PAD?

Answer 34

For salvage measures or severe cases, especially CLTI and ALI.

Question 35

Should asymptomatic PAD patients undergo revascularization just to prevent progression?

Answer 35

No. The page 22 recommendation says it should not be done solely to prevent disease progression.

Question 36

What antiplatelet approach is used in asymptomatic PAD?

Answer 36

Single antiplatelet therapy (SAPT), with no specific preference given on the slide.

Question 37

What antiplatelet options are recommended for symptomatic PAD?

Answer 37

Clopidogrel 75 mg daily or aspirin 81 mg daily.

Question 38

Which antiplatelet has higher level of evidence in symptomatic PAD on the slide?

Answer 38

Clopidogrel 75 mg daily.

Question 39

What antithrombotic regimen is recommended for symptomatic PAD?

Answer 39

Rivaroxaban 2.5 mg twice daily plus low-dose aspirin.

Question 40

In which PAD patients is low-dose rivaroxaban plus aspirin especially preferred?

Answer 40

Post-revascularization patients.

Question 41

Should full-intensity oral anticoagulation be used in PAD patients without another indication?

Answer 41

No, the slide labels this as harm.

Question 42

What is cilostazol’s mechanism?

Answer 42

PDE-3 inhibition with suppression of platelet aggregation and direct arterial vasodilation.

Question 43

What is cilostazol used for in PAD?

Answer 43

Chronic symptomatic PAD to reduce leg pain.

Question 44

What is the dose of cilostazol?

Answer 44

100 mg twice daily.

Question 45

What adverse effects are associated with cilostazol?

Answer 45

Headache, diarrhea, peripheral edema, tachycardia, and palpitations.

Question 46

What drug interactions are important with cilostazol?

Answer 46

CYP2C19 or CYP3A4 inhibitors require dose reduction.

Question 47

What is cilostazol contraindicated in?

Answer 47

Heart failure, all types.

Question 48

Does cilostazol work immediately?

Answer 48

No, it can take up to 4 months to see an effect.

Question 49

What antiplatelet should cilostazol be combined with according to the slide?

Answer 49

Aspirin or clopidogrel.

Question 50

What lipid management is recommended for PAD?

Answer 50

High-intensity statin therapy with a goal of more than 50% LDL reduction.

Question 51

When should a PCSK9 inhibitor be added in PAD?

Answer 51

When LDL-C remains 70 mg/dL or higher despite maximally tolerated statin therapy.

Question 52

When should ezetimibe be added in PAD?

Answer 52

When LDL-C remains 70 mg/dL or higher despite maximally tolerated statin therapy.

Question 53

What antihypertensive classes are recommended in PAD with hypertension to reduce MACE?

Answer 53

ACE inhibitors or ARBs.

Question 54

In PAD with type 2 diabetes, which diabetes drug classes reduce MACE?

Answer 54

GLP-1 receptor agonists and SGLT2 inhibitors.

Question 55

What preventive foot care is recommended in PAD?

Answer 55

Foot self-care education, clinician foot inspection at every visit, and therapeutic footwear for high-risk patients.

Question 56

What immunizations are recommended in PAD?

Answer 56

Annual influenza vaccination and the SARS-CoV-2 vaccine series including boosters.

Question 57

Which PAD therapies mainly reduce cardiovascular/limb risk rather than directly improve walking symptoms?

Answer 57

Aspirin, clopidogrel, rivaroxaban, ACEi/ARBs, GLP-1s, SGLT2 inhibitors, smoking cessation, and immunizations, as summarized on the PAD benefit comparison slide.

Question 58

Which PAD therapies mainly improve functional status?

Answer 58

Supervised exercise therapy, revascularization procedures, and cilostazol.