Department of Epidemiology, Erasmus MC, Rotterdam, the Netherlands.
Am J Med. 2012 Feb;125(2):198-208.e3. doi: 10.1016/j.amjmed.2011.06.027. Epub 2011 Nov 11.
Peripheral artery disease (PAD) screening may be performed to prevent progression of PAD or future cardiovascular disease in general. Recommendations for PAD screening have to be derived indirectly because no randomized trials comparing screening versus no screening have been performed. We performed a systematic review of guidelines to evaluate the value of PAD screening in asymptomatic adults.
Guidelines in English published between January 1, 2003 and January 20, 2011 were retrieved using MEDLINE, CINAHL, the National Guideline Clearinghouse, the National Library for Health, the Canadian Medication Association Infobase, and the G-I-N International Guideline Library. Guidelines developed by national and international medical societies from Western countries, containing recommendations on PAD screening, were included. Two reviewers independently assessed rigor of guideline development using the Appraisal of Guidelines Research and Evaluation (AGREE) instrument. One reviewer performed full extraction of recommendations, which was validated by a second reviewer.
Of 2779 titles identified, 8 guidelines were included. AGREE scores varied from 33% to 81%. Five guidelines advocated PAD screening, others found insufficient evidence for PAD screening or were against it. Measurement of the ankle-brachial index (ABI) was generally recommended for middle-aged populations with elevated cardiovascular risk levels. Those identified as having PAD are reclassified as high risk, warranting intensive preventive interventions to reduce their risk of a cardiovascular event. The underlying evidence mainly consisted of studies performed in patients with established PAD. A meta-analysis that evaluated ABI testing in the context of traditional cardiovascular risk assessment was interpreted differently.
Recommendations on PAD screening vary across current guidelines, making the value of PAD screening uncertain. The variation seems to reflect lack of studies that show added value of detection of early PAD beyond expectant management and traditional risk assessment.
外周动脉疾病（PAD）筛查可能用于预防 PAD 的进展或总体未来心血管疾病。由于尚未进行比较筛查与不筛查的随机试验，因此必须间接得出 PAD 筛查的建议。我们对指南进行了系统评价，以评估无症状成年人中 PAD 筛查的价值。
使用 MEDLINE、CINAHL、国家指南清除中心、国家卫生图书馆、加拿大药物协会 Infobase 和 G-I-N 国际指南库检索 2003 年 1 月 1 日至 2011 年 1 月 20 日期间发表的英文指南。纳入包含 PAD 筛查建议的来自西方国家的国家和国际医学协会制定的指南。两名审查员使用评估指南研究与评估（AGREE）工具独立评估指南制定的严谨性。一名审查员对建议进行了全面提取，由第二名审查员进行验证。
在 2779 个标题中，有 8 项指南被纳入。AGREE 评分从 33%到 81%不等。有 5 项指南主张进行 PAD 筛查，其他指南认为 PAD 筛查的证据不足或反对进行 PAD 筛查。一般建议对心血管风险水平较高的中年人群进行踝臂指数（ABI）测量。那些被确定为患有 PAD 的人被重新归类为高危人群，需要进行强化预防干预以降低其发生心血管事件的风险。这些证据主要来源于对已确诊 PAD 患者进行的研究。对在传统心血管风险评估背景下进行 ABI 检测的一项荟萃分析的解释存在差异。
当前指南对 PAD 筛查的建议存在差异，使得 PAD 筛查的价值不确定。这种差异似乎反映了缺乏研究表明早期 PAD 的检测除了预期管理和传统风险评估之外还有额外的价值。
