Peripheral artery disease (PAD) is a growing health concern globally, affecting up to 12% of the population, with prevalence rates exceeding 20% in high-risk groups.¹ However, these figures are likely underestimated due to the condition's frequent underdiagnosis, leading many patients to present at advanced stages or with complications. The implementation of multidisciplinary team care has revolutionized cardiovascular (CV) disease management, enhancing diagnostic precision and long-term treatment outcomes across various specialties, including PAD and chronic limb-threatening ischemia (CLTI). Integrating expertise from vascular specialists, primary care specialists, podiatrists, and rehabilitation professionals ensures comprehensive care tailored to individual patient needs, promoting better prognosis.

The 2024 multisociety Guideline for the Management of Lower Extremity PAD emphasizes that optimal care for patients with PAD is achieved through a multispecialty approach, acknowledging the complexity of managing this condition effectively.² Early detection and intervention are crucial for altering disease progression, reducing complications, and enhancing overall prognosis. Initiating early detection can begin with primary care providers using simple methods such as ankle-brachial index testing in those with suspected PAD or thorough history-taking to identify symptoms such as claudication. Individuals at high risk may benefit from assessment by vascular specialists who can perform additional diagnostic tests such as arterial ultrasonography, computed tomography, magnetic resonance imaging, or invasive angiography. Addressing health disparities is essential, as geographic and financial barriers can hinder early detection and specialist access, necessitating support from social work and health care financing initiatives.

Moreover, effective management of asymptomatic or mild PAD necessitates aggressive modification of risk factors, including optimizing treatment for diabetes mellitus, hyperlipidemia, hypertension, and chronic kidney disease, as well as promoting smoking cessation.^3,4 Special attention is required for the geriatric population with PAD, considering factors such as frailty, age-related muscle loss, malnutrition, mobility limitations, and the potential impact of revascularization procedures or amputation, as well as the risks associated with polypharmacy. These risks underscore the importance of interdisciplinary care involving physical medicine and rehabilitation clinicians, social workers, physical and occupational therapists, nutritionists, and dietitians. In addition, collaboration between vascular specialists and primary care specialists early in the disease course is essential to address both polyvascular and microvascular complications comprehensively. Medical management of PAD, including the appropriate use of antiplatelet agents, antithrombotic therapy, and phosphodiesterase inhibitors, should be tailored on the basis of individual patient needs. Patient education focused on self-care, disease progression awareness, foot care practices, and supervised exercise programs is crucial for effectively managing PAD and preventing complications. None of these can be effectively managed by a single health care provider alone; this reality further highlights the importance of a multispecialty approach to managing PAD.

In patients with advanced PAD leading to severe functionally limiting claudication, tissue loss, or nonhealing wounds/ulcers, interventional therapies become necessary, requiring input from vascular surgery, vascular interventional radiology, or interventional cardiology to determine the most appropriate treatment strategies.^3,4 Patients with CLTI and nonhealing wounds require coordinated multidisciplinary care, integrating revascularization and evidence-based wound management to achieve complete wound healing and preserve limb function.³ This approach includes regular wound assessments, tailored local wound-care techniques, and adjunctive therapies. Optimizing the wound-healing environment involves medical optimization, infection control, offloading pressure, and appropriate orthotics in addition to smoking cessation, glycemic control, and CV risk-factor management. CLTI represents the most severe form of PAD and requires input from multiple specialties to guide revascularization decisions, goals, and strategies, as well as postprocedural care, including wound management, infection control, and CV risk-reduction strategies; this requirement emphasizes the benefits of a multispecialty care team for comprehensive patient management.

Psychological support is paramount in managing PAD, particularly in patients facing complications such as amputations, for whom depression is prevalent. Regular psychological assessments and interventions are essential to enhance patient well-being and improve quality of life (QoL).²

In conclusion, PAD represents a significant global health burden, exacerbated by underdiagnosis and late-stage presentations. Multidisciplinary team care is the cornerstone of effective PAD management, facilitating early detection, personalized treatment strategies, and holistic patient care. By addressing clinical, psychological, and rehabilitative needs collaboratively, clinicians can optimize outcomes; reduce morbidity, limb loss, and death rates; and improve QoL for patients living with PAD and CLTI.

References

1. GBD 2019 Peripheral Artery Disease Collaborators. Global burden of peripheral artery disease and its risk factors, 1990-2019: a systematic analysis for the Global Burden of Disease Study 2019. Lancet Glob Health 2023;11:e1553-e1565.
2. Gornik HL, Aronow HD, Goodney PP, et al.; Writing Committee Members. 2024 ACC/AHA/AACVPR/APMA/ABC/SCAI/SVM/SVN/SVS/SIR/VESS guideline for the management of lower extremity peripheral artery disease: a report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. J Am Coll Cardiol 2024;83:2497-604.
3. Kolte D, Parikh SA, Piazza G, et al.; American College of Cardiology Peripheral Vascular Disease Council. Vascular teams in peripheral vascular disease. J Am Coll Cardiol 2019;73:2477-86.
4. Shishehbor MH, White CJ, Gray BH, et al. Critical limb ischemia: an expert statement. J Am Coll Cardiol 2016;68:2002-15.