Peripheral Artery Disease — ABIM Board MCQ

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ModerateCardiologyPeripheral Artery DiseaseABIM Board

A 72-year-old woman with hypertension and hyperlipidemia has reproducible calf discomfort after walking 2 blocks that resolves within several minutes of rest. Her ankle-brachial index is 0.68. She has no ischemic rest pain, foot ulceration, or history of heart failure. She is receiving antiplatelet and high-intensity statin therapy and begins a supervised exercise program. Which additional therapy is recommended specifically to improve her leg symptoms and walking distance?

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Correct answer: E — Cilostazol

Cilostazol is recommended for patients with intermittent claudication to improve leg symptoms and increase walking distance. Her reproducible exertional calf pain relieved by rest, abnormal ankle-brachial index, and absence of rest pain or tissue loss establish chronic symptomatic PAD with claudication. Cilostazol should not be used in patients with heart failure of any severity, which is specifically excluded here. Warfarin does not improve claudication and full-intensity anticoagulation is harmful in PAD without another indication. Niacin does not provide symptomatic walking benefit, and opioids neither correct exercise-induced ischemia nor improve functional capacity. Therefore, pharmacotherapy need not be withheld: cilostazol can be used alongside structured exercise and cardiovascular risk-reduction therapy.

Reference: Gornik HL, Aronow HD, Goodney PP, et al. 2024 ACC/AHA/AACVPR/APMA/ABC/SCAI/SVM/SVN/SVS/SIR/VESS Guideline for the Management of Lower Extremity Peripheral Artery Disease, section on medications for leg symptoms in chronic symptomatic PAD. 2024. https://www.acc.org/latest-in-cardiology/ten-points-to-remember/2024/05/09/15/00/2024-guideline-for-lower-extremity-pad