Epidemiology of PAD in the elderly
As China rapidly ages, the prevalence of peripheral artery disease (PAD), particularly in the elderly population, is showing a significant upward trend. A meta-analysis
[1] that included 37 studies from China showed an estimated 40% increase in the total number of PAD patients in China between 2000 and 2020. The number of patients may have more than doubled, especially in the 65–69 and 85+ age groups. The 2019 Global Burden of Disease Study
[2] reported the following prevalence rates of PAD in the elderly population for 2019: 6.7% for the 65–69 age group, 8.8% for the 70–74 group, 10.9% for the 75–79 group, 13.1% for the 80–84 group, and 16.5% for the 85–89 group. Compared to younger individuals, elderly PAD patients are more likely to have comorbidities such as hypertension, diabetes, dyslipidemia, and a history of smoking. These factors not only significantly increase their risk of developing PAD but are also closely associated with adverse outcomes like major adverse cardiovascular events (MACE), major adverse limb events (MALE), and death.
Recommendation 1
1-1: The prevalence of PAD increases significantly with age, and it is notably higher in the elderly population, causing a severe disease burden.
1-2: Elderly PAD patients often have multiple risk factors associated with poor prognosis, which require greater clinical attention.
Etiology and risk factors of PAD in the elderly
The primary cause of PAD in the elderly is atherosclerosis. Common risk factors include traditional factors (advanced age, smoking, diabetes, hypertension, dyslipidemia, and obesity) as well as other factors requiring attention, such as hyperhomocysteinemia, a history of cardiovascular and cerebrovascular diseases, and chronic kidney disease. Concurrently, a growing body of research suggests that chronic mental and psychosocial stress may influence the onset and progression of PAD
[1,3]. Additionally, acute limb ischemia is another severe manifestation of PAD in the elderly, significantly increasing the risk of amputation. Its main causes include cardiogenic embolism due to inadequate anticoagulation in patients with atrial fibrillation (the most common cause), and secondary thrombosis in the context of lower extremity arterial stenosis combined with hypercoagulable states such as malignancy, limited mobility, or systemic inflammation.
Recommendation 2
2-1: For elderly PAD patients, comprehensive management of common atherosclerotic risk factors should be strengthened, with attention also paid to managing behavioral patterns, socioeconomic, and psychological factors.
2-2: The prevention of acute ischemic events in elderly PAD patients is crucial. Management of anticoagulation for atrial fibrillation and effective prevention of thrombotic events in hypercoagulable states should be enhanced.
Diagnosis of PAD in the elderly
Elderly individuals often have coexisting conditions like diabetes, neuropathy, and osteoarthritis, leading to overlapping symptoms. This can result in early PAD symptoms being overlooked and delayed treatment for more complex later-stage symptoms. Therefore, a detailed and accurate medical history, physical examination (including assessment of the legs, feet, and pulses), and ancillary tests are crucial for a definitive diagnosis of PAD and for the differential assessment of comorbidities in the elderly.
Clinical manifestations of PAD in the elderly
PAD in the elderly can be classified as symptomatic (approximately 70%–80%) or asymptomatic. Asymptomatic patients often have more comorbidities and a higher rate of amputation and mortality
[4]. It is important to be vigilant that geriatric syndromes (including frailty, sarcopenia, and malnutrition) may lead to a decline in limb function that can mask PAD-related symptoms until the disease reaches an advanced stage. For patients with intermittent claudication, rest pain, or ulceration due to chronic limb-threatening ischemia (CLTI), it is necessary to differentiate these from conditions common in the elderly, such as neurogenic claudication from lumbar disc herniation or spinal stenosis, venous claudication, osteoarthritic claudication, diabetic peripheral neuropathy, and purely diabetic ulcers. Some elderly patients may have multiple overlapping pathologies, which severely complicates the diagnosis and treatment of PAD
[5]. Commonly used staging methods include the Fontaine classification and the Rutherford classification (Table 1), as well as the Wound, Ischemia, and foot Infection (WIfI) classification system (Table 2).
Moreover, clinical symptoms in the elderly with PAD are frequently atypical. Rather than classic, well-localized calf claudication, elderly patients more commonly pre-sent with diffuse lower-limb weakness, exercise-induced fatigue, heaviness, or a general reduction in walking speed and endurance. These subtle and nonspecific manifestations are often attributed erroneously to age-related deconditioning or musculoskeletal disorders, leading to diagnostic delay. A high index of suspicion is therefore warranted, and PAD should be considered in any elderly patient reporting unexplained decline in ambulatory capacity, even in the absence of typical intermittent claudication.
Physical signs of PAD in the elderly
Common physical signs of PAD in the elderly include changes in skin color (pallor or cyanosis), hair loss, thin skin, thickened nails, and decreased skin temperature; weakened or absent lower extremity arterial pulses; and ulcers or gangrene on the feet or toes. Dystrophic changes in the toes and compensatory loss of muscle volume due to long-term chronic ischemia are important signs.
Diagnostic examinations for PAD in the elderly
The resting ankle-brachial index (ABI) is the most commonly used non-invasive assessment method, with a diagnostic criterion of ABI ≤ 0.9
[6]. It is particularly suitable for screening and postoperative dynamic monitoring in elderly patients
[7]. Some elderly patients with severe vascular calcification may have falsely elevated ABI results, which should be carefully interpreted in conjunction with physical examination and other ancillary tests. Color Doppler ultrasound is the preferred imaging modality
[8], providing important information for clinical decision-making. Computed tomography angiography (CTA), magnetic resonance angiography (MRA), and digital subtraction angiography (DSA) are important for assessing the extent of lesions and selecting surgical methods and approaches. CTA and DSA involve contrast agents and radiation exposure, so their use requires a careful evaluation of the patient’s specific condition and potential risks.
Recommendation 3
3-1: A detailed and accurate medical history and physical examination are particularly crucial for establishing a diagnosis of PAD in the elderly.
3-2: For elderly patients with suspected PAD or clinical symptoms of intermittent claudication, non-invasive hemodynamic or morphological examinations, such as ABI and lower extremity color Doppler ultrasound, are recommended as initial steps.
3-3: To further clarify the severity of the lesions, CTA, MRA, or DSA is recommended to facilitate planning for revascularization solutions. Renal and cardiac function should be assessed in elderly patients before performing CTA or DSA.
3-4: In clinical practice, for elderly patients with symptoms of intermittent claudication or limb ulcers, it is especially important to differentiate from diabetic peripheral neuropathy, neurogenic claudication due to lumbar disc herniation or spinal stenosis, and neurogenic ulcers.
3-5: For patients with CLTI, the WIfI classification system is recommended for clinical grading and assessment.
Health status and frailty assessment in elderly PAD patients
Studies have shown that in community-dwelling elderly individuals, an ABI < 1.0 is an independent risk factor for a lower quality of life
[9]. Research also suggests an interaction between low ABI and symptoms of depression and hopelessness. Therefore, a comprehensive assessment of health status and frailty is crucial for elderly PAD patients.
Prioritize assessment of comorbidities, geriatric syndromes, and their impact
Elderly PAD patients commonly present with geriatric syndromes (frailty, cognitive impairment, multimorbidity, and polypharmacy), which significantly increase the risk of disability from the disease
[10]. Especially for CLTI patients, a vicious cycle is formed between lower limb dysfunction and chronic inflammation (from ischemia, tissue loss, and chronic infection), exacerbating the progression of frailty
[11]. The presence of geriatric syndromes further increases the risk of MACE, MALE, and all-cause mortality. Therefore, before revascularization in elderly PAD patients, a comprehensive assessment of comorbidities, frailty status, and functional reserve is necessary (Table 3). This should be followed by enhanced pharmacological intervention and rehabilitation support. The risks and benefits of intervention must be carefully weighed, and shared decision-making with the patient should be prioritized when formulating invasive treatment plans.
Among the multimorbidities discussed above, type 2 diabetes mellitus (T2DM) warrants particular emphasis, given the ongoing pandemic of new-onset diabetes in the aging population. Diabetes and PAD frequently coexist and interact synergistically to accelerate limb-threatening complications. In elderly patients with this dual burden, an active watchful policy—defined as a structured, prospective surveillance strategy targeting the earliest detectable signs of diabetic foot disease and vascular deterioration—is essential to prevent rapid progression toward chronic limb-threatening ischemia and amputation.
Diabetic peripheral neuropathy diminishes protective sensation, masking ischemic warning symptoms and predisposing patients to unrecognized trauma, ulceration, and infection. Routine screening with 10-g monofilament testing and vibratory perception assessment should therefore be integrated into the periodic vascular follow-up of all elderly diabetic PAD patients. Furthermore, diabetic angiopathy superimposed on pre-existing peripheral arterial occlusive disease (PAOD) produces a distinct vascular phenotype characterized by diffuse, multisegmental, and predominantly below-the-knee arterial involvement. The late-stage diabetic vasculopathy of the lower limb encompasses three interrelated processes: diabetic macroangiopathy accelerating iliofemoral and infrapopliteal atherosclerosis, below-the-knee PAD constituting the most challenging revascularization target, and arterial intima-media calcification, which is markedly more prevalent in diabetic patients. This calcification pattern not only renders the ABI falsely elevated due to non-compressible arteries but also increases vessel rigidity, complicating endovascular intervention and impairing wound healing capacity. Complementary assessments including the toe-brachial index, transcutaneous oxygen pressure measurement, and duplex ultrasound should therefore be employed in diabetic elderly PAD patients to accurately evaluate perfusion status. Regarding pharmacotherapy, emerging evidence suggests that glucagon-like peptide-1 receptor agonists (GLP-1 RAs) may confer limb-protective benefits beyond glycemic control through anti-inflammatory and endothelial-protective mechanisms, whereas concerns persist regarding a potential increased amputation risk with certain sodium-glucose cotransporter-2 inhibitors
[12,13]. A comprehensive pharmacological strategy integrating antiplatelet therapy, aggressive lipid lowering, and careful selection of glucose-lowering agents with proven cardiovascular and limb safety profiles is therefore recommended in this high-risk population.
Benefits of a multidisciplinary team for comprehensive assessment and shared decision-making
The UK’s best practice guidelines for the management of PAD patients state that geriatricians can provide benefits in supporting shared decision-making and perioperative care for elderly or frail CLTI patients, and recommend their inclusion as core members of the vascular multidisciplinary team
[14]. A recent survey of Belgian geriatricians indicated that vascular surgery has the second-highest demand for geriatric support among surgical specialties (second only to orthopedics)
[15]. Therefore, screening elderly PAD surgical patients for frailty, cognitive impairment, and delirium, and providing support from a geriatric medicine team, combined with shared decision-making, will bring greater health benefits.
Recommendation 4
4-1: A comprehensive assessment of health status, comorbidities, and frailty is crucial for elderly PAD patients.
4-2: Elderly PAD patients also have a high prevalence of geriatric syndromes, such as frailty, cognitive impairment, multimorbidity, and polypharmacy, which often worsen the impact of the disease.
4-3: For elderly PAD surgical patients, receiving a health status and frailty assessment supported by a geriatric medicine team, combined with shared decision-making, will bring greater health benefits.
Treatment of PAD in the elderly
General treatment
Diet
A Mediterranean dietary pattern is recommended for elderly PAD patients, which involves increasing the intake of fruits, vegetables, legumes, fiber, unsaturated fatty acids, nuts, and fish, while reducing the proportion of refined carbohydrates, red meat, saturated fatty acids, and dairy products. Patients with coexisting hypertension should limit their salt intake
[16].
While the Mediterranean diet is recommended as the preferred dietary pattern for patients with PAD
[17], its modified counterpart—the Dietary Approaches to Stop Hypertension (DASH) diet—may offer additional advantages in the elderly PAD population by explicitly emphasizing sodium restriction and blood pressure control. The DASH diet, which is rich in fruits, vegetables, whole grains, and low-fat dairy products while limiting saturated fat and sodium, has received a Class I recommendation in both the 2023 ESH hypertension guidelines and the 2019 ACC/AHA primary prevention guideline for patients with cardiovascular risk factors and established atherosclerotic disease
[18,19]. Given the high prevalence of coexisting hypertension in elderly PAD patients, the sodium-restrictive component of the DASH diet is of particular clinical relevance. Regarding blood pressure targets, the 2024 ESC guidelines for peripheral arterial and aortic diseases recommend a systolic blood pressure target of 120–129 mmHg in patients with peripheral arterial and aortic diseases (PAAD) and hypertension
[17], while the 2023 ESH guidelines define a diastolic target range of 70–80 mmHg
[18]. For elderly PAD patients in whom aggressive lowering may increase the risk of limb hypoperfusion due to fixed arterial stenoses, targeting the upper portion of these ranges—approximately 125–129 mmHg systolic and 70–75 mmHg diastolic—represents a prudent balance between cardiovascular risk reduction and limb safety. Therefore, for elderly PAD patients with concomitant hypertension and atherosclerotic burden, the DASH dietary pattern, combined with careful blood pressure management, constitutes an optimal nutritional and hemodynamic strategy.
Exercise
Supervised exercise therapy (SET) is recommended to improve functional status, walking ability, and quality of life in patients with chronic symptomatic PAD
[20]. Vascular specialists should not advise unstructured exercise programs like “just take a walk,” which should only be considered when a structured exercise program is not available to the patient in a medical setting.
Psychological intervention
It is recommended to use psychological scales such as the Self-Rating Anxiety Scale (SAS) and the Self-Rating Depression Scale (SDS) for assessment, and to seek assistance from a psychologist when necessary. For elderly individuals living alone, community doctors should provide emotional support
[1]. Additionally, strengthening disease-related education can enhance exercise adherence, improving treatment cooperation and quality of life.
Smoking cessation
For all PAD patients who smoke, it is recommended to offer both behavioral interventions and pharmacotherapy to aid smoking cessation, as this is the most effective approach to achieve successful quitting
[21].
Comorbidity management
A comprehensive assessment of the overall health status of elderly PAD patients can better identify underlying health issues and help formulate individualized treatment plans, thereby maintaining their physical health and improving their quality of life
[22]. For robust elderly individuals, the focus is on disease control and functional maintenance. For frail elderly individuals, the emphasis is more on symptom management and safety optimization, especially reducing adverse events from polypharmacy.
Recommendation 5
5-1: For elderly PAD patients, a Mediterranean dietary pattern is recommended.
5-2: For elderly PAD patients, SET is recommended to improve walking ability.
5-3: Elderly PAD patients should be screened for coexisting psychological disorders such as anxiety and depression. Timely psychological intervention should be provided if indicated.
5-4: Smoking cessation is recommended for all elderly PAD patients who smoke.
5-5: For the management of comorbidities in elderly PAD patients, a comprehensive geriatric assessment should be conducted to promptly identify geriatric syndromes and comorbidities and to formulate individualized treatment plans.
Pharmacotherapy
Pharmacotherapy for elderly PAD patients aims to control the underlying causes, alleviate symptoms, and reduce the risk of cardiovascular events. The treatment principles follow a strategy of individualized medication, long-term management, and regular monitoring.
Antiplatelet therapy
Antiplatelet drugs are foundational medications. Aspirin and clopidogrel are commonly used, typically as monotherapy. For some elderly patients with complex vascular lesions and a high risk of re-occlusion after procedures, a combination of aspirin 100 mg/day and rivaroxaban 2.5 mg twice daily may be considered. However, special attention must be paid to the risk of bleeding, especially in patients with a history of gastrointestinal ulcers
[23,24].
Symptomatic relief medications
Vasodilators, including sarpogrelate and beraprost sodium, help to dilate blood vessels and improve lower limb circulation. These drugs have relatively minor side effects, but attention should be paid to adverse reactions in the elderly, such as headache, dizziness, abdominal pain, and palpitations, as well as the increased risk of bleeding when used in combination with multiple drugs.
Lipid-lowering and plaque stabilization
Statins have lipid-lowering and plaque-stabilizing effects. It is recommended that elderly PAD patients use statins to control low-density lipoprotein cholesterol (LDL-C) levels to < 2.6 mmol/L. For patients at high ischemic risk, it is recommended to control LDL-C levels to < 1.8 mmol/L. Elderly patients should be particularly monitored for the risk of myopathy and rhabdomyolysis, with regular monitoring of creatine kinase (CK) and liver function. Fibrates are also an effective treatment option
[25].
Other therapies
Gene therapy and stem cell therapy have shown promise in the treatment of elderly PAD by significantly improving patients’ walking distance and quality of life, while also reducing pain and ulcer occurrence. However, more research evidence is needed to support their use.
Recommendation 6
6-1: Pharmacotherapy for elderly PAD aims to control etiology, alleviate symptoms, and reduce the risk of cardiovascular events.
6-2: Medication is the cornerstone of treatment, and its principles should follow an individualized, comprehensive and long-term management strategy.
Surgical treatment
Principles of assessment and treatment for revascularization in elderly PAD
Elderly PAD patients often present with complex vascular lesions, multiple chronic underlying diseases, and geriatric syndromes, leading to limited overall physiological reserve. This results in decreased tolerance to revascularization surgery and a significantly increased risk associated with treatment
[20]. Therefore, the goal of revascularization should focus on short-term clinical benefits, such as alleviating ischemic symptoms, preserving limb function, and improving quality of life, rather than overemphasizing the complete anatomical reconstruction or long-term vessel patency. Endovascular therapy should be the preferred revascularization modality, especially for patients with high surgical risk or anatomical conditions suitable for it. Open surgery should be reserved for lower-risk patients, those with complex lesions, or cases where endovascular therapy has failed.
Indications for surgery in PAD
For patients with symptomatic PAD (e.g., intermittent claudication) whose symptoms persist and affect their quality of life after at least 3 months of optimal medical therapy and a structured exercise program, revascularization may be considered. For patients with CLTI, revascularization should be performed as early as possible for limb salvage, with a comprehensive evaluation by a multidisciplinary team to select the most appropriate strategy. For patients with acute limb ischemia, emergency revascularization should be performed, provided the limb is salvageable
[17]. For patients where the cost or duration of treatment is too high, or if the limb continues to deteriorate after revascularization, early amputation may be considered when the expected benefits are lower than the risks
[17].
Revascularization methods
For patients with a clear indication for revascularization, minimally invasive endovascular therapy is the first choice. Open surgery is typically reserved for patients in whom endovascular therapy has failed or who have extensive occlusive disease. For complex, multi-level lesions, it is recommended that a multidisciplinary team comprehensively assess the lesion location, anatomical features, and individual risks to jointly decide on an endovascular or open surgical strategy.
Amputation
Elderly patients face high rates of complications and mortality after amputation, with the mortality rate increasing by approximately 4% for each additional year of age
[26]. The decision to amputate should be made after a thorough evaluation by experienced revascularization specialists and a multidisciplinary team, with in-depth communication with the patient and their family to respect their wishes and treatment goals. For very elderly patients, especially those with multiple underlying diseases, regional anesthesia or nerve block anesthesia should be prioritized. The amputation level should balance the potential for wound healing with the degree of functional preservation, with a preference for a function-preserving amputation level that facilitates postoperative rehabilitation
[20].
Recommendation 7
7-1: It is recommended that under the guidance of a multidisciplinary team, an individualized treatment strategy oriented towards short-term clinical benefits be developed for elderly PAD patients, based on their clinical presentation, anatomical features, frailty status, comorbidities, and personal preferences.
7-2: Endovascular therapy should be the preferred revascularization method, especially for patients with higher surgical risk or favorable anatomy. Open surgery should be reserved for patients with complex lesions, failed endovascular therapy, or acceptable risk.
7-3: The decision for amputation should be based on a comprehensive assessment of wound healing potential and functional preservation needs, prioritizing a function-preserving amputation level. Regional anesthesia is recommended. A personalized follow-up plan should be developed postoperatively, covering foot care, biomechanical interventions, and functional rehabilitation to optimize long-term outcomes.
Integrated traditional Chinese and Western medicine
Principles of combined internal use of Chinese and Western medicine
Standardized Western medicine is the foundation of treatment for elderly PAD. However, for some elderly patients who cannot tolerate surgical intervention, have contraindications to antithrombotic therapy, or experience significant drug side effects, traditional Chinese medicines (TCM) that promote blood circulation, remove blood stasis, and unblock collaterals to relieve pain can be used as a synergistic treatment. Based on the principle of “treatment based on syndrome differentiation,” TCM aims to promote tissue repair by regulating the body’s yin-yang balance and improving the flow of qi and blood. Modern pharmacological studies have confirmed that
Astragalus,
Ramulus Cinnamomi,
Panax notoginseng saponins, and
Salvia miltiorrhiza preparations have unique advantages in promoting collateral circulation, anti-inflammation, anti-oxidation, and protecting the endothelium, respectively
[27,28]. It must be noted that there is currently insufficient evidence to support the replacement of core Western medical treatments with TCM. Further research into mechanisms and clinical trial design are key areas for future breakthroughs.
Integrated external therapies for ulcers in elderly PAD
In the TCM external therapy system, chronic ulcers are categorized as “chuāng yáng” (sores and ulcers). The core pathogenesis is described as “imbalance of yin and yang, with deficiency of vital qi and lingering of pathogenic factors.” The clinical treatment follows a stepwise principle: “open a drainage pathway → Chinese medicine encircling and protecting the wound → Chinese medicine debride to regenerate → moist environment promotes granulation → slough off, tissue on by Chinese medicine → granulation and epithelialization.” Combining this with modern wound management techniques through an integrated Chinese-Western approach can effectively improve healing efficiency and reduce the burden of home care.
For patients whose blood supply has not been or cannot be restored, TCM strategies can enhance efficacy while avoiding excessive debridement and preventing the expansion of necrosis. Methods include soaking, fumigation/washing, and topical application of Chinese herbs to control infection and reduce swelling and pain. Commonly used formulas include Ba Du Sheng Ji San (Detoxifying and Flesh-Generating Powder) and Ru Yi Huang Jin San (As-You-Wish Golden Yellow Powder), as well as other formulas with heat-clearing, detoxifying, anti-inflammatory, and anti-pruritic effects. Some literature reports that combining these with the internal administration of Gu Bu Tang (Step-Securing Decoction) can further improve outcomes
[29,30].
For patients treated after blood supply has been restored, TCM can be used synergistically to promote healing on top of standard debridement and wound closure techniques. Studies have shown that extracts of
Plectranthus amboinicus and total glucosides of
Centella asiatica can improve the healing of diabetic foot ulcers by modulating the balance of M1/M2 macrophages
[31,32].
Recommendation 8
8-1: When surgical treatment or conservative Western medical therapy is not feasible, ineffective, or not tolerated by elderly PAD patients, TCM with effects such as promoting blood circulation, removing blood stasis, and unblocking collaterals can be used to improve microcirculation and promote tissue repair.
8-2: For elderly PAD patients with ulcers, TCM external therapies such as containing and protecting the surrounding area (Ru Yi Huang Jin San), removing necrotic tissue and promoting granulation (Ba Du Sheng Ji San), and promoting regeneration (extracts of Plectranthus amboinicus, total glucosides of Centella asiatica) can be used to promote ulcer healing.
Postoperative management of elderly PAD patients
The goals of postoperative management for elderly PAD patients focus on the recovery of limb function and reducing the rates of cardiovascular events and restenosis. It emphasizes individualized principles and the implementation of simplified protocols matched to the physiological characteristics of the elderly
[33]. Elderly PAD patients often have poorer self-management abilities, requiring increased attention from medical staff, especially regarding perioperative and postoperative regular follow-up and exercise management
[34].
Perioperative management
From admission, the responsible nurse and attending physician should provide patient education, including guidance on diet, medication, and psychological support. Health education should be integrated throughout the entire hospitalization and treatment process. For patients with memory impairment, family members can be instructed to assist with management, set alarms for regular medication, and complex medical orders should be avoided as much as possible.
Regular postoperative follow-up management
Post-discharge follow-up can take various forms. Since elderly PAD patients may not readily accept newer health education methods like WeChat or mobile Apps, telephone follow-up is the preferred method. A dedicated telephone follow-up team can be established within the department. If any changes in the patient’s condition are identified during a telephone follow-up, a further outpatient visit can be recommended
[35]. For patients with significant cognitive decline, establishing a follow-up method that involves family members is encouraged.
Exercise management
As peripheral blood flow improves after endovascular treatment in elderly PAD patients, preoperative symptoms like rest pain are alleviated. Postoperative exercise management can further improve walking disability and quality of life. Systematic exercise under the guidance of a professional can not only improve maximal walking distance but also reduce the risk of future major cardiovascular events
[20,36]. This includes SET and community-based systematic exercise programs (such as guided home-based exercise)
[37]. The effectiveness of self-directed “going for a walk” type of exercise in improving claudication distance for patients with chronic symptomatic PAD is uncertain. Furthermore, when elderly PAD patients begin exercise early in the postoperative period, safety must be ensured. It is strongly recommended to start with low-to-moderate intensity exercise and gradually increase the intensity over 2–3 months. The standard for increasing intensity is a perceived exertion level between “extremely light” and “somewhat hard,” with no discomfort. This gradual transition helps to reduce potential cardiovascular risks
[38]. While an optimal exercise prescription for the elderly has not yet been established in China, the application of specific exercise prescriptions needs to fully consider the clinical reality, the patient’s condition and personal preferences, and feasibility and applicability, to effectively improve the functional status of the elderly
[39].
Postoperative management of elderly PAD patients involves multidisciplinary collaboration. It is best to establish a multidisciplinary team, including vascular surgery, cardiology, geriatrics, nutrition, to jointly provide comprehensive diagnosis, treatment, and management services for elderly PAD patients.
Recommendation 9
9-1: Elderly PAD patients have poorer self-management abilities; therefore, perioperative health education should be strengthened and provided throughout the entire hospitalization period.
9-2: Elderly PAD patients require systematic exercise management and regular follow-up to transition from revascularization to functional reconstruction of the affected limb.
9-3: It is recommended that elderly PAD patients who are physically able conduct regular moderate- or high-intensity physical activity.
9-4: SET and community-based systematic exercise programs both have good therapeutic effects.
9-5: Postoperative exercise management for elderly PAD patients should be guided by an exercise prescription, with attention paid to the safety of the exercise.
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