Peripheral Artery Disease: New Concepts, Treatments, and Disparities.

Abstract

Peripheral artery disease (PAD) is a prevalent and underdiagnosed atherosclerotic condition affecting more than 10 million adults in the United States. PAD is a marker of systemic vascular disease and a strong predictor of myocardial infarction, stroke, and mortality. Despite its clinical importance, PAD remains underrecognized due to variable presentation, limitations in screening, and disparities in diagnosis and treatment. This review examines contemporary PAD epidemiology, diagnostic strategies (including the ankle-brachial index), and evidence-based management approaches, from supervised exercise to surgical revascularization. It also highlights the evolving debate on PAD screening guidelines and presents emerging evidence favoring targeted screening in high-risk populations. Importantly, the review explores structural inequities, racial and ethnic disparities, and geographic variation in PAD-related outcomes, particularly amputation. These disparities persist even after adjustment for comorbidities and socioeconomic factors. Addressing PAD effectively requires comprehensive strategies that include early diagnosis, equitable access to care, and policy initiatives.