2023
Lower extremity symptoms and ankle–brachial index screening as predictors of cardiovascular outcomes in Black adults
Lee M, Smolderen K, Ionescu C, Hillegass W, Romain G, Mena-Hurtado C. Lower extremity symptoms and ankle–brachial index screening as predictors of cardiovascular outcomes in Black adults. Vascular Medicine 2023, 28: 197-204. PMID: 37293738, DOI: 10.1177/1358863x231151729.Peer-Reviewed Original ResearchMeSH KeywordsAdultAgedAnkle Brachial IndexFemaleHumansIntermittent ClaudicationLower ExtremityMaleMiddle AgedPeripheral Arterial DiseaseRisk FactorsConceptsPeripheral artery diseaseAbnormal ABILower extremity symptomsNormal ABILeg symptomsHigh riskBlack adultsExtremity symptomsStepwise Cox proportional hazards modelKaplan-Meier survival curvesCox proportional hazards modelAnkle-brachial indexFramingham risk factorsJackson Heart StudyProportional hazards modelCardiovascular outcomesCause mortalityArtery diseaseAsymptomatic diseaseAdverse outcomesMean ageSymptom assessmentAsymptomatic participantsRisk factorsSymptomatic participants
2022
One-Year Health Status Outcomes Following Early Invasive and Noninvasive Treatment in Symptomatic Peripheral Artery Disease
Angraal S, Hejjaji V, Tang Y, Gosch KL, Patel MR, Heyligers J, White CJ, Nolthenius R, Mena-Hurtado C, Aronow HD, Moneta GL, Fitridge R, Soukas PA, Abbott JD, Secemsky EA, Spertus JA, Smolderen KG. One-Year Health Status Outcomes Following Early Invasive and Noninvasive Treatment in Symptomatic Peripheral Artery Disease. Circulation Cardiovascular Interventions 2022, 15: e011506. PMID: 35579010, PMCID: PMC11299756, DOI: 10.1161/circinterventions.121.011506.Peer-Reviewed Original ResearchMeSH KeywordsFemaleHealth StatusHumansIntermittent ClaudicationMalePeripheral Arterial DiseaseProspective StudiesQuality of LifeTreatment OutcomeConceptsHealth status outcomesPropensity-matched sampleEarly invasiveHealth statusEarly revascularizationStatus outcomesSymptomatic peripheral artery diseaseDisease-specific health statusNoninvasive management strategiesPeripheral Artery QuestionnaireTreatment-resistant symptomsEarly invasive managementPeripheral artery diseaseBaseline health statusEarly invasive treatmentHealth status trajectoriesHealth status improvementReal-world evidencePORTRAIT registryArtery diseaseInvasive managementNoninvasive managementPatient preferencesInvasive treatmentLifestyle changes
2021
Exercise therapy referral and participation in patients with peripheral artery disease: Insights from the PORTRAIT registry
Gupta T, Manning P, Kolte D, Smolderen KG, Stone N, Henry JG, Wang J, Gosch KL, White CJ, Spertus J, Abbott J. Exercise therapy referral and participation in patients with peripheral artery disease: Insights from the PORTRAIT registry. Vascular Medicine 2021, 26: 654-656. PMID: 34404282, DOI: 10.1177/1358863x211033649.Peer-Reviewed Original ResearchEstablishing Thresholds for Minimal Clinically Important Differences for the Peripheral Artery Disease Questionnaire
Peri-Okonny PA, Wang J, Gosch KL, Patel MR, Shishehbor MH, Safley DL, Abbott JD, Aronow HD, Mena-Hurtado C, Jelani QU, Tang Y, Bunte M, Labrosciano C, Beltrame JF, Spertus JA, Smolderen KG. Establishing Thresholds for Minimal Clinically Important Differences for the Peripheral Artery Disease Questionnaire. Circulation Cardiovascular Quality And Outcomes 2021, 14: e007232. PMID: 33947205, PMCID: PMC8254614, DOI: 10.1161/circoutcomes.120.007232.Peer-Reviewed Original ResearchMeSH KeywordsAgedFemaleHumansIntermittent ClaudicationMinimal Clinically Important DifferencePeripheral Arterial DiseaseQuality of LifeSurveys and QuestionnairesConceptsPAQ summary scorePeripheral Artery QuestionnaireGlobal assessmentPatient's perspectiveSummary scoresDisease-specific health status instrumentHealth status assessment toolMinimal Clinically Important DifferencePAQ scoresPatient-reported outcomesRoutine clinical careHealth status instrumentsClinically Important DifferenceMultivariable linear regressionPORTRAIT registryDisease QuestionnaireMultivariable adjustmentVascular clinicMean ageUS cohortClinical trialsClinical careMCIDMCID estimatesMean differenceTreatment decisions for patients with peripheral artery disease and symptoms of claudication: Development process and alpha testing of the SHOW-ME PAD decision aid
Smolderen KG, Pacheco C, Provance J, Stone N, Fuss C, Decker C, Bunte M, Jelani QU, Safley DM, Secemsky E, Sepucha KR, Spatz ES, Mena-Hurtado C, Spertus JA. Treatment decisions for patients with peripheral artery disease and symptoms of claudication: Development process and alpha testing of the SHOW-ME PAD decision aid. Vascular Medicine 2021, 26: 273-280. PMID: 33627058, PMCID: PMC8169642, DOI: 10.1177/1358863x20988780.Peer-Reviewed Original ResearchMeSH KeywordsDecision Support TechniquesHumansIntermittent ClaudicationPeripheral Arterial DiseaseQuality of LifeSurveys and QuestionnairesConceptsPeripheral artery diseaseArtery diseaseTreatment optionsSymptoms of claudicationInvasive treatment optionNon-invasive treatmentQuality of lifeClaudication symptomsClaudication treatmentPatient knowledgeSpecialty careTreatment decisionsDecision aidPatientsCliniciansDecisional needsInternational Patient Decision Aid Standards criteriaStandard criteriaPrototype decision aidImplementation logisticsSymptomsDecisional qualityDiseaseTreatmentClaudication
2020
Physical Activity After Treatment for Symptomatic Peripheral Artery Disease
Peri-Okonny PA, Patel S, Spertus JA, Jackson EA, Malik AO, Provance J, Mena-Hurtado C, Shishehbor MH, Hijjaji V, Gosch KL, Smolderen K. Physical Activity After Treatment for Symptomatic Peripheral Artery Disease. The American Journal Of Cardiology 2020, 138: 107-113. PMID: 33065083, PMCID: PMC7736254, DOI: 10.1016/j.amjcard.2020.10.011.Peer-Reviewed Original ResearchMeSH KeywordsAgedAnkle Brachial IndexConservative TreatmentEndovascular ProceduresExerciseExercise TherapyFemaleHealth StatusHumansHydroxymethylglutaryl-CoA Reductase InhibitorsIntermittent ClaudicationLeisure ActivitiesLinear ModelsLogistic ModelsMaleMiddle AgedMultivariate AnalysisPatient SatisfactionPeripheral Arterial DiseasePlatelet Aggregation InhibitorsQuality of LifeSedentary BehaviorSmoking CessationSocial InteractionVascular Surgical ProceduresWorkConceptsPhysical activity levelsPhysical activityInvasive treatmentSymptomatic peripheral artery diseasePeripheral artery diseaseMultivariable logistic regressionAssociation of treatmentActivity levelsMultivariable linear regressionHealth status changesHealth status gainsPAD outcomesArtery diseaseVascular clinicInvasive groupNoninvasive treatmentHealth statusLogistic regressionActivity statusLTPAClaudicationTreatmentPatientsStatus changesAssociationPhysical Activity in Patients with Symptomatic Peripheral Artery Disease: Insights from the PORTRAIT Registry
Peri-Okonny PA, Gosch K, Patel S, Heyligers JMM, Mena-Hurtado C, Shishebor M, Malik A, Provance J, Hejjaji V, Spertus JA, Smolderen KG. Physical Activity in Patients with Symptomatic Peripheral Artery Disease: Insights from the PORTRAIT Registry. European Journal Of Vascular And Endovascular Surgery 2020, 60: 889-895. PMID: 32709469, PMCID: PMC7749016, DOI: 10.1016/j.ejvs.2020.06.010.Peer-Reviewed Original ResearchConceptsPeripheral artery diseaseSupervised exercisePhysical activityArtery diseaseSedentary behaviorSedentary participantsSymptomatic peripheral artery diseasePeripheral arterial diseasePhysical activity levelsPoisson regression analysisPORTRAIT registryCardiovascular eventsCurrent smokersArterial diseaseLifestyle factorsExercise referralFunctional impairmentPatientsNetherlands cohortActive lifestyleTreatment practicesReferralDiseaseActivity levelsMonthsImpact of Kidney Disease on Peripheral Arterial Interventions: A Systematic Review and Meta-Analysis
Anantha-Narayanan M, Sheikh AB, Nagpal S, Smolderen KG, Turner J, Schneider M, Llanos-Chea F, Mena-Hurtado C. Impact of Kidney Disease on Peripheral Arterial Interventions: A Systematic Review and Meta-Analysis. American Journal Of Nephrology 2020, 51: 527-533. PMID: 32570255, DOI: 10.1159/000508575.Peer-Reviewed Original ResearchConceptsCKD/ESRDCritical limb ischemiaPAD interventionsMajor amputationEarly mortalitySystematic reviewCKD/ESRD patientsPeripheral arterial disease interventionsHigher major amputationOutcomes of patientsPeripheral arterial interventionsSuch comorbid conditionsESRD patientsLimb ischemiaArterial interventionsComorbid conditionsRandomized trialsKidney diseasePatient populationESRDObservational studyRisk populationsFunnel plotPatientsMeta-AnalysisCilostazol and peripheral artery disease-specific health status in ambulatory patients with symptomatic PAD
Mohammed M, Gosch K, Safley D, Jelani QU, Aronow HD, Mena C, Shishehbor MH, Spertus JA, Abbott JD, Smolderen KG. Cilostazol and peripheral artery disease-specific health status in ambulatory patients with symptomatic PAD. International Journal Of Cardiology 2020, 316: 222-228. PMID: 32464249, DOI: 10.1016/j.ijcard.2020.05.042.Peer-Reviewed Original ResearchMeSH KeywordsAgedCilostazolFemaleHealth StatusHumansIntermittent ClaudicationMaleMiddle AgedPeripheral Arterial DiseaseQuality of LifeTetrazolesConceptsPeripheral Artery QuestionnaireHealth statusDisease-specific health statusPatient-reported health statusHeart failure historyNon-cilostazol groupUse of cilostazolPAQ scoresImprovement of symptomsSubsequent health statusQuality of lifeCilostazol therapyCilostazol useSymptomatic PADPatient characteristicsPharmacological optionsAmbulatory patientsLimitation scoresMean ageFunctional statusUS cohortTreatment goalsSummary scoresCilostazolPatientsLevel of disease and association with health status in patients presenting with claudication from the PORTRAIT registry
Vogel TR, Braet DJ, Kruse RL, Bath J, Wang J, Gosch K, Smolderen KG. Level of disease and association with health status in patients presenting with claudication from the PORTRAIT registry. Journal Of Vascular Surgery 2020, 72: 2017-2026. PMID: 32325227, DOI: 10.1016/j.jvs.2020.03.042.Peer-Reviewed Original ResearchMeSH KeywordsAgedFemaleFunctional StatusHealth Status IndicatorsHumansIntermittent ClaudicationMaleMiddle AgedPatient SatisfactionPeripheral Arterial DiseasePredictive Value of TestsQuality of LifeRegistriesRetrospective StudiesSeverity of Illness IndexSurveys and QuestionnairesTime FactorsTreatment OutcomeConceptsPeripheral artery diseasePAQ summary scorePeripheral Artery QuestionnaireQuality of lifeAnkle-brachial indexMultilevel diseaseAortoiliac diseaseHealth statusAnatomic levelSummary scoresMedical managementHigh ankle-brachial indexFemoral-popliteal diseaseTreatment of aortoiliacChronic kidney diseaseHistory of diabetesPAQ scoresPeripheral arterial diseaseOverall health statusSimilar health statusHealth status informationStudent's t-testLevel of diseaseRepeated-measures analysisInfrapopliteal disease
2019
Ankle-brachial index in patients with intermittent claudication is a poor indicator of patient-centered and clinician-based evaluations of functional status
Johnston AL, Vemulapalli S, Gosch KL, Aronow HD, Abbott JD, Patel MR, Smolderen KG, Shishebor M, Spertus JA, Jones WS. Ankle-brachial index in patients with intermittent claudication is a poor indicator of patient-centered and clinician-based evaluations of functional status. Journal Of Vascular Surgery 2019, 69: 906-912. PMID: 30626552, DOI: 10.1016/j.jvs.2018.07.039.Peer-Reviewed Original ResearchMeSH KeywordsAgedAnkle Brachial IndexAustraliaCost of IllnessFemaleHealth StatusHemodynamicsHumansIntermittent ClaudicationMaleMiddle AgedNetherlandsPatient Reported Outcome MeasuresPeripheral Arterial DiseasePredictive Value of TestsProspective StudiesQuality of LifeRegistriesSeverity of Illness IndexUnited StatesConceptsAnkle-brachial indexPeripheral artery diseasePeripheral Artery QuestionnaireIntermittent claudicationRutherford classificationABI valuesPAQ scoresArtery diseaseImpact of PADHealth statusMean ankle-brachial indexPAD-specific health statusSevere peripheral artery diseasePAQ summary scoreStudy of patientsQuality of lifeHealth status assessmentRutherford classNew onsetPatient's symptomsHemodynamic assessmentLife scoresFunctional statusPatients' perceptionsInternational cohort
2018
Guideline‐directed statin intensification in patients with new or worsening symptoms of peripheral artery disease
Khariton Y, Patel KK, Chan PS, Pokharel Y, Wang J, Spertus JA, Safley DM, Hiatt WR, Smolderen KG. Guideline‐directed statin intensification in patients with new or worsening symptoms of peripheral artery disease. Clinical Cardiology 2018, 41: 1414-1422. PMID: 30284297, PMCID: PMC6489902, DOI: 10.1002/clc.23087.Peer-Reviewed Original ResearchMeSH KeywordsAgedAustraliaDisease ProgressionDyslipidemiasFemaleGuideline AdherenceHumansHydroxymethylglutaryl-CoA Reductase InhibitorsIntermittent ClaudicationMaleMiddle AgedNetherlandsPeripheral Arterial DiseasePractice Guidelines as TopicPractice Patterns, Physicians'Prospective StudiesRegistriesTime FactorsTreatment OutcomeUnited StatesConceptsPeripheral artery diseaseAdjusted median odds ratioStatin intensificationClaudication symptomsStatin therapyGuideline therapyArtery diseaseSpecialty clinicACC/AHA cholesterol guidelinesHigh-intensity statin treatmentHigh-intensity statinsLow-intensity statinsProvider-level variationMedian odds ratioCholesterol guidelinesPORTRAIT registryMost patientsOlder patientsPAD symptomsStatin treatmentMedical therapyPatient factorsAppropriate therapyOdds ratioLower oddsUnderutilization of Evidence‐Based Smoking Cessation Support Strategies Despite High Smoking Addiction Burden in Peripheral Artery Disease Specialty Care: Insights from the International PORTRAIT Registry
Patel KK, Jones PG, Ellerbeck EF, Buchanan DM, Chan PS, Pacheco CM, Moneta G, Spertus JA, Smolderen KG. Underutilization of Evidence‐Based Smoking Cessation Support Strategies Despite High Smoking Addiction Burden in Peripheral Artery Disease Specialty Care: Insights from the International PORTRAIT Registry. Journal Of The American Heart Association 2018, 7: e010076. PMID: 30371269, PMCID: PMC6474973, DOI: 10.1161/jaha.118.010076.Peer-Reviewed Original ResearchConceptsVascular specialty clinicsPeripheral artery diseaseCessation interventionsActive smokersSpecialty clinicEvidence-based cessation interventionsThird of patientsProbability of relapseImportant risk factorBackground SmokingInitial quittersPORTRAIT registryCessation counselingPharmacologic treatmentArtery diseaseInitial visitSmoking statusCessation supportSmoking cessationTreatment courseSpecialty careRisk factorsSmoking ratesPAD managementPatientsAssociations of exercise ankle–brachial index, pain-free walking distance and maximum walking distance with the Peripheral Artery Questionnaire: Finding from the PORTRAIT PAD Registry
Hammad TA, Smolderen KG, Spertus JA, Jones PG, Shishehbor MH. Associations of exercise ankle–brachial index, pain-free walking distance and maximum walking distance with the Peripheral Artery Questionnaire: Finding from the PORTRAIT PAD Registry. Vascular Medicine 2018, 24: 32-40. PMID: 29992849, DOI: 10.1177/1358863x18785026.Peer-Reviewed Original ResearchConceptsPain-free walking distancePeripheral artery diseaseMaximum walking distancePeripheral Artery QuestionnairePhysical limitation scoreWalking distancePatient factorsLimitation scoresImpact of PADAnkle-brachial index (ABI) testExercise ankle-brachial indexOnset of claudicationPost-exercise ABIAnkle-brachial indexQuality of lifeHierarchical logistic regression modelsLogistic regression modelsPORTRAIT registryArtery diseasePatient's symptomsPatient functioningABI testingSummary scoresHealth statusSymptomsRacial Heterogeneity in Treatment Effects in Peripheral Artery Disease
Pokharel Y, Jones PG, Graham G, Collins T, Regensteiner JG, Murphy TP, Cohen D, Spertus JA, Smolderen K. Racial Heterogeneity in Treatment Effects in Peripheral Artery Disease. Circulation Cardiovascular Quality And Outcomes 2018, 11: e004157. PMID: 29643064, PMCID: PMC5901766, DOI: 10.1161/circoutcomes.117.004157.Peer-Reviewed Original ResearchBlack or African AmericanCanadaEndovascular ProceduresExercise TherapyExercise ToleranceFemaleHealth Status DisparitiesHumansIntermittent ClaudicationMaleMiddle AgedPeripheral Arterial DiseaseQuality of LifeRecovery of FunctionSurveys and QuestionnairesTime FactorsTreatment OutcomeUnited StatesWalk TestWhite PeoplePORTRAIT (Patient-Centered Outcomes Related to Treatment Practices in Peripheral Arterial Disease
Smolderen KG, Gosch K, Patel M, Jones WS, Hirsch AT, Beltrame J, Fitridge R, Shishehbor MH, Denollet J, Vriens P, Heyligers J, Stone MEd N, Aronow H, Abbott JD, Labrosciano C, Tutein-Nolthenius R, A Spertus J. PORTRAIT (Patient-Centered Outcomes Related to Treatment Practices in Peripheral Arterial Disease. Circulation Cardiovascular Quality And Outcomes 2018, 11: e003860. PMID: 29440123, DOI: 10.1161/circoutcomes.117.003860.Peer-Reviewed Original ResearchMeSH KeywordsAgedAustraliaCardiovascular AgentsExercise TherapyFemaleHealth StatusHealth Status IndicatorsHealthcare DisparitiesHumansIntermittent ClaudicationLife StyleMaleMiddle AgedMulticenter Studies as TopicNetherlandsPatient Outcome AssessmentPeripheral Arterial DiseaseProspective StudiesQuality of LifeRegistriesResearch DesignRisk FactorsSurveys and QuestionnairesTime FactorsTreatment OutcomeUnited StatesVascular Surgical ProceduresConceptsHealth status outcomesHealth statusMedical historyMedical recordsStatus outcomesAbnormal ankle-brachial indexPAD-related hospitalizationAnkle-brachial indexCardiovascular risk factorsMajor cardiovascular eventsPatients' medical recordsComparative effectiveness studiesHealth status dataPatient's medical historyPatients' health statusQuality of lifeClaudication symptomsEligible patientsCardiovascular eventsPAD symptomsPatient characteristicsClinician adherenceRisk stratificationLifestyle factorsFunctional statusAssociation between health status and sociodemographic, clinical and treatment disparities in the Patient-centered Outcomes Related to TReatment Practices in Peripheral Arterial Disease: Investigating Trajectories (PORTRAIT) registry
Noyes AM, Abbott JD, Gosch K, Smolderen K, Spertus JA, Hyder O, Soukas P, Shishehbor MH, Aronow HD. Association between health status and sociodemographic, clinical and treatment disparities in the Patient-centered Outcomes Related to TReatment Practices in Peripheral Arterial Disease: Investigating Trajectories (PORTRAIT) registry. Vascular Medicine 2018, 23: 32-38. PMID: 29338591, DOI: 10.1177/1358863x17747047.Peer-Reviewed Original ResearchConceptsPeripheral artery diseasePoor health statusIntermittent claudicationHealth statusPatient characteristicsDisease-specific health status measuresNon-vascular factorsPeripheral arterial diseaseChronic lung diseaseSpecialty care visitsTime of presentationHealth status measuresMultivariable linear regressionPatients' health statusQuality of lifeCare visitsArtery diseaseInitial presentationArterial diseaseBack painExercise programTreatment disparitiesLung diseaseFemale sexFunctional status
2017
Sex differences in disease-specific health status measures in patients with symptomatic peripheral artery disease: Data from the PORTRAIT study
Roumia M, Aronow HD, Soukas P, Gosch K, Smolderen KG, Spertus JA, Abbott JD. Sex differences in disease-specific health status measures in patients with symptomatic peripheral artery disease: Data from the PORTRAIT study. Vascular Medicine 2017, 22: 103-109. PMID: 28429659, DOI: 10.1177/1358863x16686408.Peer-Reviewed Original ResearchMeSH KeywordsAgedAnkle Brachial IndexAustraliaChi-Square DistributionCost of IllnessFemaleHealth Status DisparitiesHealth Status IndicatorsHumansIntermittent ClaudicationLinear ModelsLogistic ModelsMaleMental HealthMiddle AgedMultivariate AnalysisNetherlandsPatient SatisfactionPeripheral Arterial DiseasePrognosisProspective StudiesQuality of LifeRisk FactorsSeverity of Illness IndexSex FactorsSocial BehaviorSocioeconomic FactorsSurveys and QuestionnairesUnited StatesConceptsPeripheral artery diseasePeripheral Artery QuestionnaireHealth statusArtery diseaseSymptoms of PADAnkle-brachial index valuesPAD-specific health statusSymptomatic peripheral artery diseaseDisease-specific health status measuresPAQ scoresPeripheral arterial diseaseSex differencesHealth status domainsInternational prospective studyPoor health statusHealth status measuresMultivariable linear regressionLower PAQ scoresBaseline characteristicsClinical characteristicsPAD symptomsTreatment satisfactionArterial diseaseProspective studyFemale sex
2012
Self-reported symptoms on questionnaires and anatomic lesions on duplex ultrasound examinations in patients with peripheral arterial disease
van Zitteren M, Vriens PW, Heyligers JM, Burger DH, Nooren MJ, de Fijter WM, Denollet J, Smolderen KG. Self-reported symptoms on questionnaires and anatomic lesions on duplex ultrasound examinations in patients with peripheral arterial disease. Journal Of Vascular Surgery 2012, 55: 1025-1034.e2. PMID: 22244858, DOI: 10.1016/j.jvs.2011.10.115.Peer-Reviewed Original ResearchMeSH KeywordsAge FactorsCross-Sectional StudiesFemaleFollow-Up StudiesHumansIntermittent ClaudicationLogistic ModelsLower ExtremityMaleMultivariate AnalysisOdds RatioPain MeasurementPeripheral Arterial DiseaseRisk FactorsSelf ReportSeverity of Illness IndexSurveys and QuestionnairesUltrasonography, Doppler, DuplexConceptsPeripheral arterial diseaseCardiovascular risk factorsDuplex ultrasound examinationDistal lesionsProximal lesionsLesion locationLeg symptomsPatient characteristicsSelf-reported symptomsArterial diseaseRisk factorsUltrasound examinationLower extremity peripheral arterial diseaseVascular surgery outpatient clinicMultivariable logistic regression analysisExertional leg symptomsNew-onset symptomsCardiovascular risk profileSurgery outpatient clinicMain outcome measuresCross-sectional studyFurther diagnostic imagingLogistic regression analysisTailor-made managementPAD subgroups
2009
Lower-leg symptoms in peripheral arterial disease are associated with anxiety, depression, and anhedonia
Smolderen KG, Hoeks SE, Pedersen SS, van Domburg RT, de Liefde II, Poldermans D. Lower-leg symptoms in peripheral arterial disease are associated with anxiety, depression, and anhedonia. Vascular Medicine 2009, 14: 297-304. PMID: 19808714, DOI: 10.1177/1358863x09104658.Peer-Reviewed Original ResearchConceptsAtypical leg symptomsPeripheral arterial diseaseExertional leg symptomsAnkle-brachial indexLeg symptomsIntermittent claudicationDepressive symptomsPAD patientsClinical factorsArterial diseaseAnkle-brachial index screeningSan Diego Claudication QuestionnaireClassic intermittent claudicationConsecutive PAD patientsLower leg symptomsDiverse clinical manifestationsErasmus Medical CenterMood statesSub-threshold symptomsCardiovascular historyMedication useTwofold riskClinical manifestationsPoor prognosisHospital Anxiety