The Role of Arterial Stiffness in the Prognosis, Assessment, and Treatment of Patients with Peripheral Artery Disease: A Comprehensive Review

Peripheral artery disease (PAD) is a prevalent and disabling vascular condition characterized by progressive atherosclerotic narrowing and stiffening of peripheral arteries. Arterial stiffness, most accurately measured by pulse wave velocity (PWV), has gained prominence as a critical biomarker in the assessment and management of PAD. Unlike traditional diagnostic tools that focus primarily on anatomical lesions, PWV offers dynamic insights into vascular function, elasticity, and systemic cardiovascular risk. Elevated PWV has been consistently associated with adverse outcomes in PAD patients, including critical limb ischemia, restenosis following angioplasty, amputation, and cardiovascular mortality. It not only reflects disease severity but also facilitates early risk stratification, informs treatment selection, and enables monitoring of therapeutic efficacy. Studies have shown that reductions in arterial stiffness following angioplasty, pharmacological therapy, or lifestyle interventions correlate with improved limb perfusion and long-term clinical outcomes. Moreover, in elderly PAD patients, arterial stiffness often coexists with frailty-another key predictor of poor prognosis. Emerging evidence suggests that both conditions may share pathophysiological pathways related to vascular aging and sarcopenia. The integration of PWV into routine PAD evaluation may thus offer a more holistic understanding of patient risk and resilience. Given its diagnostic, prognostic, and therapeutic utility, arterial stiffness-particularly as assessed by PWV-should be considered an essential parameter in PAD management. Incorporating this measurement into clinical practice holds significant potential to improve individualized care, reduce complications, and enhance overall patient outcomes.