Current diagnostic and therapeutic approaches for peripheral arterial disease in Italy: a survey among vascular specialists of the Italian society of angiology and vascular medicine (SIAPAV) and general practitioners of the Italian federation of general practitioners (FIMMG).

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.