Peripheral Arterial Disease (PAD) is a perilous condition silently affecting millions worldwide.  This blog is designed as a short guide for general practitioners and other medical professionals. It contains global and some local statistics of PAD prevalence, presents PAD risk groups, and discusses the compounding effect of smoking and multiple risk factors. It also features basic information on the Ankle-Brachial Index (ABI) as a diagnostic tool, explaining its reference scale and pulse waveform recording, as well as cases when the Toe-Brachial Index is used. You can also download the article as a handy brochure.
In this blog you will learn:
Peripheral Arterial Disease (PAD) is atherosclerosis (plaque buildup) in the arteries supplying the legs.  It is a frequent but underdiagnosed condition, often with severe consequences. They include death, stroke, coronary heart disease, amputations, dementia and cognitive impairment.
Here is some global and local information about its prevalence. PAD affects:
The latest AHA Scientific Statement recommends that PAD screening with ABI is urgently implemented in high-risk populations. TBI should be employed if suspecting medial artery calcification, e.g. in cases of chronic kidney disease (CKD) or diabetes. 
Smoking is a major risk factor in developing PAD. Smokers are at 2x greater risk of PAD compared to non-smokers. With former smokers, it takes up to 30 years for the PAD risk to reach the non-smoker level. 
The duration of hypercholesterolemia and diabetes, the severity of hypertension, and cumulative intensity of smoking show graded relationships with PAD risk. 
70% of patients with PAD do not experience symptoms and are thus not diagnosed. The TASC II consensus document recommends Ankle-Brachial Index measurement for all PAD risk groups. 
The Ankle-Brachial Index (ABI) is an effective comparison of blood pressure in the legs and the arms. It is non-invasive and painless. Using MESI mTABLET ABI, the procedure is quick and simple. Therefore, the test can be implemented routinely in both primary and specialised care. The ABI test is extremely important for two reasons:
Let’s take a look at normal and abnormal results of the ABI pulse waveform recording on the MESI mTABLET ABI – a digital, automated ABI-measuring device.
The oscillation graph forms a clear lemon shape. This means that the arteries are elastic and that they responded to being briefly compressed by the cuff. The pulse waveforms have these characteristics (cf. the illustration):
A flattened pulsewave recording or one without the typical lemon shape is an indicator of severe PAD.
The absence of the pulsations caused by occlusions in the artery makes it impossible to calculate the ankle pressures. Instead of the ABI value, the device will display a “PAD” result.
The illustration shows a flattened pulsewave recording.
ESC Guidelines state the following recommendations in connection with ABI measuring :
The Toe-Brachial Index (TBI) is a comparison of blood pressure in the toes and the arms. It is used in diagnosing PAD: