Last reviewed: November 2017
Last updated: April  2016



History and exam

Key diagnostic factors

  • presence of risk factors
  • asymptomatic
  • intermittent claudication
  • thigh or buttock pain with walking that is relieved with rest
  • sudden onset of severe leg pain accompanied by numbness, weakness, pale, and cold leg
  • diminished pulse
  • no pulse in lower extremity

Other diagnostic factors

  • erectile dysfunction
  • pain worse in one leg
  • leg pain at rest
  • gangrene
  • non-healing wound/ulcer
  • muscle atrophy
  • dependent rubor
  • pallor when the leg is elevated
  • loss of hair over the dorsum of the foot
  • thickened toenails
  • shiny/scaly skin
  • pale extremity
  • nerve loss

Risk factors

  • smoking
  • diabetes
  • hypertension
  • hyperhomocysteinaemia
  • elevated C-reactive protein
  • hyperlipidaemia
  • age >40 years
  • history of coronary artery disease/cerebrovascular disease
  • low levels of exercise
  • vasculitis/inflammatory conditions
  • arterial fibrodysplasia
  • trauma

Diagnostic investigations

1st investigations to order

  • ankle brachial index (ABI)
Full details

Investigations to consider

  • toe brachial index (TBI)
  • segmental pressure examination
  • duplex ultrasound
  • pulse volume recording (PVR)
  • continuous wave Doppler ultrasound
  • exercise ABI
  • angiography
  • CT angiogram
  • MR angiography (MRA)
Full details

Treatment algorithm


Authors VIEW ALL

Associate Professor of Medicine

Division of Cardiology

University of Colorado School of Medicine

Director, Interventional Cardiology

Director, Vascular Laboratory

VA Eastern Colorado Healthcare System




EA is an advisory board member for Abbott Vascular, Boston Scientific, Medtronic, Merck, and Spectranetics.

Dr Ehrin Armstrong would like to gratefully acknowledge Dr Kosmas I. Paraskevas, a previous contributor to this monograph. KIP is an author of references cited in this monograph.

Peer reviewers VIEW ALL

Assistant Professor

Division of Cardiovascular Medicine

University of Kentucky




KZ declares that he has no competing interests.

Gill Foundation Professor of Interventional Cardiology

Director of Cardiac Catheterization Laboratories

Gill Heart Institute

Division of Cardiovascular Medicine

University of Kentucky




DM declares that he has no competing interests.

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