Clinical symptoms associated with asymptomatic peripheral arterial disease: A literature review

Background: The incidence and prevalence of Peripheral Arterial Disease (PAD) is rising, yet physician awareness is insufficient. This review aims to increase awareness and detection of asymptomatic PAD in primary care, dermatologic, or podiatric practices through observable symptoms and subtle pathologies concomitant with PAD so patients may benefit from preliminary screening. Methods: A systematic review of Google Scholar for literature establishing a link between PAD and observable symptoms or examinable pathologies that could be ascertained in primary care. Results: 31 manuscripts were included. Four discussed examinable symptoms of PAD. Significant ORs predicted PAD by ABI < 0.9 for cool skin, cyanosis, or lower-extremity wounds or sores (6.4, 3.8, 6.0, respectively). Four papers described clinical tests, with diminished capillary refill time, venous filling time, unilateral absence of foot pulses, mild unilateral weakness in foot pulses (OR 8.6), auscultation of femoral bruit (OR 7.8), weak unilateral femoral pulse (OR 3.7), or absent and normal femoral pulses in opposite legs (OR 6.1) significantly predicting PAD. Four papers discussed PAD as an independent predictor of onychomycosis with risk odds-ratio (ROR) 4.8. Six papers investigated onychomycosis’ relation to psoriasis, while another six mentioned psoriasis predicting PAD (OR 1.98; RR 2.6). Four studies demonstrated diminished peripheral nerve performance in PAD, and five mentioned PAD-related ulceration and the disease’s ability to disrupt wound-healing (OR 2.31). Conclusion: PAD is underdiagnosed, an issue that may be improved through increasing educational outreach awareness of the asymptomatic disease, and ability to detect subtle risk factors, symptoms, and pathologies predictive of PAD.