Santini Paolo, Marrocco Walter, Marrocco Gianmarco, Fazzari Amalia Lucia, Amato Corrado, Favaretto Elisabetta, Porfidia Angelo, Visonà Adriana, Ageno Walter, Martini Romeo
Department of Geriatric, Orthopedic, and Rheumatologic Sciences, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy.
Italian Federation of General Practitioners (FIMMG), Rome, Italy.
Intern Emerg Med. 2025 May 30. doi: 10.1007/s11739-025-03974-8.
Peripheral Arterial Disease (PAD) is a widespread and frequently neglected condition, affecting around 245 million people worldwide. Despite its association with increased cardiovascular morbidity and mortality, including myocardial infarction, stroke, and limb amputation, PAD remains poorly recognized, particularly in asymptomatic patients. Although the ankle-brachial index (ABI) is the standard non-invasive method for diagnosing PAD, its utilization remains limited due to insufficient awareness. This study aimed to assess diagnostic and therapeutic approaches to PAD in Italy through a survey conducted between March 2023 and September 2023 among members of the Italian Society of Angiology and Vascular Medicine (SIAPAV) and the Italian Federation of General Practitioners (FIMMG). The responses from 110 out of 300 SIAPAV members (36.7%) and 232 out of 1.175 FIMMG members (19.7%) highlighted a gap between clinical practice and guideline recommendations. The survey revealed a notable underuse of the Ankle-Brachial Index (ABI) as first diagnostic approach (50.9% in SIAPAV responders, 28.5% in FIMMG responders). Moreover, the results pointed to suboptimal risk stratification practices, with many healthcare providers failing to accurately assess the overall cardiovascular risk in PAD patients. Furthermore, the widespread use of antiplatelet therapy for primary prevention in asymptomatic PAD patients is still a prevalent practice (44.6% in SIAPAV members, 62.5% in FIMMG members), with the potential for increased bleeding risk in this population. The survey underscored the need for improved PAD education among general practitioners and vascular specialists, particularly concerning the use of ABI, cardiovascular risk stratification, and lipid-lowering therapies. Enhanced collaboration between primary care and specialists is essential for optimizing PAD diagnosis and treatment, alongside the integration of new pharmacological strategies. This study emphasizes the importance of continued medical education and multidisciplinary approaches to address the underdiagnosis and undertreatment of PAD.
外周动脉疾病（PAD）是一种普遍存在且常常被忽视的疾病，全球约有2.45亿人受其影响。尽管PAD与心血管发病率和死亡率的增加有关，包括心肌梗死、中风和肢体截肢，但PAD仍然未得到充分认识，尤其是在无症状患者中。虽然踝臂指数（ABI）是诊断PAD的标准非侵入性方法，但由于认识不足，其应用仍然有限。本研究旨在通过2023年3月至2023年9月期间对意大利血管病学和血管医学学会（SIAPAV）成员以及意大利全科医生联合会（FIMMG）成员进行的一项调查，评估意大利PAD的诊断和治疗方法。300名SIAPAV成员中有110名（36.7%）回复，1175名FIMMG成员中有232名（19.7%）回复，这些回复凸显了临床实践与指南建议之间的差距。调查显示，作为首选诊断方法，踝臂指数（ABI）的使用明显不足（SIAPAV回复者中为50.9%，FIMMG回复者中为28.5%）。此外，结果表明风险分层做法欠佳，许多医疗服务提供者未能准确评估PAD患者的整体心血管风险。此外，无症状PAD患者广泛使用抗血小板治疗进行一级预防仍是一种普遍做法（SIAPAV成员中为44.6%，FIMMG成员中为62.5%），这可能会增加该人群的出血风险。调查强调，需要加强全科医生和血管专科医生对PAD的教育，特别是关于ABI的使用、心血管风险分层和降脂治疗。基层医疗与专科医生之间加强合作对于优化PAD的诊断和治疗至关重要，同时还需要整合新的药物治疗策略。本研究强调了继续医学教育和多学科方法对于解决PAD诊断不足和治疗不足问题的重要性。
