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Int J Angiol
DOI: 10.1055/a-2809-5934
Review Article

Screening and Early Diagnosis of Asymptomatic Peripheral Artery Disease

Authors

  • Kunal Sharma

    1   Department of Internal Medicine, Texas Tech University Health Sciences Center, El Paso, Texas, United States

  • Lakshmi Kattamuri 

    1   Department of Internal Medicine, Texas Tech University Health Sciences Center, El Paso, Texas, United States

  • Debabrata Mukherjee 

    2   Division of Cardiology, Department of Internal Medicine, Texas Tech University Health Sciences Center, El Paso, Texas, United States
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Abstract

Asymptomatic peripheral artery disease (PAD), present in 50 to 70% of all PAD cases, carries substantial cardiovascular and limb-related risks, yet remains clinically underrecognized. Despite a low ankle–brachial index (ABI) predicting 1.5- to 2.5-fold increased cardiovascular mortality and progressive limb disease, the translation from detection to clinical benefit remains uncertain. The 2018 U.S. Preventive Services Task Force concluded that the evidence is insufficient to support universal ABI screening in asymptomatic adults. This narrative review synthesized evidence on asymptomatic PAD screening and early diagnosis via PubMed/MEDLINE search (inception to December 2025) and targeted review of guidelines, high-quality evidence, with priority given to randomized trials, observational cohorts, systematic reviews, and meta-analyses addressing test performance, feasibility, and linkage of detection to actionable care pathways. Asymptomatic PAD affects 8.5 million Americans and 200 million people globally, with highest prevalence in African-American populations (27–30% lifetime risk). Low ABI independently predicts cardiovascular mortality, major adverse events, and impaired functional capacity. Risk-stratified screening demonstrates cost-effectiveness, though medial arterial calcification limits ABI reliability in diabetes and chronic kidney disease. No large randomized trials directly demonstrate that screening-detected PAD, when coupled with structured intervention, improves clinical outcomes. Early detection of asymptomatic PAD identifies high-risk patients warranting intensive preventive therapy. Targeted screening in high-risk populations appears reasonable; however, systematic implementation requires validated protocols, clear interpretation algorithms, and proven downstream care pathways. Outcome-driven trials directly testing screening-based interventions remain essential to resolve the screening debate.

Keywords

peripheral arterial disease - asymptomatic - screening - ankle–brachial index - ultrasound - diagnosis - guidelines

Declaration of GenAI Use

During the preparation of this manuscript, the authors used AI-assisted tools only for language editing (grammar/clarity) and formatting support such as table layout. AI tools were not used to generate scientific content, perform analyses, interpret evidence, or create original figures. All authors reviewed, edited, and take full responsibility for the accuracy, originality, and integrity of the content.


Contributors' Statement

L.K. contributed to conceptualization, methodology, investigation (literature search), writing, reviewing, and editing of original draft; K.S. contributed to conceptualization, methodology, investigation (literature search), writing, reviewing, and editing of original draft; D.M. contributed to conceptualization, supervision, writing, reviewing, and editing of original draft.




Publication History

Received: 15 January 2025

Accepted: 09 February 2026

Article published online:
19 February 2026

© 2026. International College of Angiology. This article is published by Thieme.

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