Evidence-based analysis of peripheral arterial disease screening based on the WHO criteria

INTRODUCTION: Peripheral arterial disease ( PAD) is an increasingly prevalent condition caused by atherosclerosis of the lower limb arteries. The majority of patients with PAD also have atherosclerosis of the coronary and cerebral vessels, therefore screening for PAD may detect patients at risk of myocardial infarction and/or stroke, but the clinical benefit of mass screening for PAD is uncertain. EVIDENCE ACQUISITION: Using the ten WHO criteria for evaluation of a screening program, we analyzed the potential merits of conducting PAD screening, using ABPI, by reviewing the evidence within the domain of each individual criterion. A comprehensive literature search was systematically carried out in order to identify relevant articles in relation to PAD screening. An evaluation and critical overview of all evidence in favor of and against the implementation of PAD screening was undertaken. EVIDENCE SYNTHESIS: Screening for PAD fits most of the WHO criteria. On current evidence, and generally in line with current guidelines, a potential target population could include anybody aged 70 years or older and those aged 45-69 with at least one risk factor for PAD. However, evidence on the cost-effectiveness of screening is based purely on theoretical modelling. Furthermore, the benefits of some secondary prevention measures, such as antiplatelet therapy and statin therapy, in asymptomatic patients are uncertain. CONCLUSIONS: Randomized trials evaluating PAD screening in asymptomatic individuals at risk are needed before widespread implementation can be advocated. Further studies assessing the merits of commencing anti-platelet and statin therapy are also required.