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J Vasc Surg. 2015 Mar;61(3 Suppl):42S-53S. doi: 10.1016/j.jvs.2014.12.008. Epub 2015 Feb 23.

A systematic review for the screening for peripheral arterial disease in asymptomatic patients.

Author information

1
Knowledge and Evaluation Research Unit, Department of Medicine, Mayo Clinic, Rochester, Minn; Division of Preventive, Occupational and Aerospace Medicine, Mayo Clinic, Rochester, Minn.
2
Knowledge and Evaluation Research Unit, Department of Medicine, Mayo Clinic, Rochester, Minn; Division of General Internal Medicine, Harbor UCLA Medical Center, Torrance, Calif.
3
Division of Vascular Surgery, University of Oklahoma, Tulsa, Okla.
4
Minneapolis Heart Institute Foundation at Abbott Northwestern Hospital, Vascular and Endovascular Surgery, Minneapolis, Minn.
5
Knowledge and Evaluation Research Unit, Department of Medicine, Mayo Clinic, Rochester, Minn.
6
Knowledge and Evaluation Research Unit, Department of Medicine, Mayo Clinic, Rochester, Minn; Mayo Clinic Libraries, Mayo Clinic, Rochester, Minn.
7
Knowledge and Evaluation Research Unit, Department of Medicine, Mayo Clinic, Rochester, Minn; Division of Endocrinology and Diabetes, Mayo Clinic, Rochester, Minn.
8
Division of Vascular and Endovascular Surgery, University of California San Francisco, San Francisco, Calif.
9
Knowledge and Evaluation Research Unit, Department of Medicine, Mayo Clinic, Rochester, Minn; Division of Preventive, Occupational and Aerospace Medicine, Mayo Clinic, Rochester, Minn. Electronic address: murad.mohammad@mayo.edu.

Abstract

BACKGROUND:

Peripheral arterial disease (PAD) is common and associated with significant morbidity and mortality. PAD can be detected through a noninvasive measurement of the ankle-brachial index (ABI).

METHODS:

We conducted a systematic review of several electronic bibliographic databases for studies that evaluated ABI as a screening test for PAD in asymptomatic individuals. We conducted random-effects meta-analysis, reporting pooled hazard ratios (HRs) when appropriate.

RESULTS:

We included 40 individual studies, 2 systematic reviews, and 1 individual-patient data meta-analysis. We found no studies comparing ABI screening with no screening in terms of patient-important outcomes (mortality, amputations). The yield of PAD screening averaged 17% (range, 1%-42%) and was 1% to 4% in lower risk populations. Patients with PAD had higher adjusted risk of all-cause mortality (HR, 2.99; 95% confidence interval, 2.16-4.12) and of cardiovascular mortality (HR, 2.35; 95% confidence interval, 1.91-2.89). Data on benefits, harms, and cost-effectiveness of screening were limited; however, ABI screening was associated with additional prognostic information and risk stratification for heart disease. The overall quality of evidence supporting screening was low.

CONCLUSIONS:

The current available evidence demonstrates that PAD is common in patients with multiple cardiovascular risk factors and is associated with significant morbidity and mortality, but it does not support the benefit of routine ABI screening.

PMID:
25721066
DOI:
10.1016/j.jvs.2014.12.008
[Indexed for MEDLINE]
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