Peripheral arterial disease of lower extremities
ICD-10 I73.9 · ICD-11 BD4Z&XA8DW5

Treatment of Peripheral Arterial Disease with Low Ankle-Brachial Index (Asymptomatic, No Exercise-Induced Ischaemia)

This protocol covers atherosclerotic lower limb peripheral arterial disease confirmed by an ankle-brachial index (ABI) ≤ 0.9 in patients without exercise-induced lower limb ischaemic symptoms — the asymptomatic stage (Rutherford grade 0 / Fontaine stage I). The absence of exertional symptoms distinguishes this group on history and clinical vascular examination. At this stage, comprehensive cardiovascular risk factor control is the central priority.

Clinical Scenario

Atherosclerotic lower limb PAD confirmed by ankle-brachial index ≤ 0.9. The patient has no exercise-induced lower limb ischaemic symptoms — classified as asymptomatic PAD (Rutherford grade 0 / Fontaine stage I). An ABI ≤ 0.90 is the established diagnostic threshold for confirming PAD.

Management Approach (Partial Overview)

The recommended approach is best medical therapy with cardiovascular risk factor management — high-intensity lipid-lowering therapy is central, alongside antihypertensive and lifestyle-based interventions. Neither antithrombotic therapy nor revascularisation is indicated at this asymptomatic stage. The complete evidence-based regimen — including the full sequence of interventions and specific agents — is available in the structured protocol.

Treatment Targets

Instant Access to Structured Evidence-Based Regimens

References

DOI: 10.1016/j.ejvs.2023.08.067

atherosclerotic lower extremity peripheral arterial disease (PAD, see also section 2.1) falling within the following clinical stages: (1) asymptomatic lower limb PAD (Rutherford grade 0/Fontaine stage I); and (2) intermittent claudication (IC, Rutherford grade IeIII/Fontaine stage IIa and IIb).

asymptomatic PAD and IC are discriminated by the absence (asymptomatic PAD) or presence (IC) of exercise induced lower limb symptoms deemed to be of ischaemic origin based on history, clinical presentation, and a thorough clinical vascular examination.

An ABI ≤ 0.90 is the threshold for confirming the diagnosis of PAD.

For all patients with asymptomatic lower limb peripheral arterial disease, high intensity statin treatment is recommended to reduce the subsequent risk of major cardiovascular events, limb events, and disease progression.

For patients with lower limb peripheral arterial disease, it is recommended to reduce the low density lipoprotein cholesterol concentrations to < 1.4 mmol/L (< 55 mg/dL) and decrease it by ≥ 50% if baseline values are within 55–110 mg/dL.

For patients with lower limb peripheral arterial disease, it is recommended to reduce the blood pressure to ≤ 120–129/80 mmHg in patients < 70 years and to ≤ 130–139/80 mmHg in patients ≥ 70 years to reduce the risk of major adverse cardiovascular events.

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