Peripheral arterial disease (PAD) is most commonly caused by atherosclerosis.
Most patients are asymptomatic.
Patients require aggressive risk factor control.
Long-term patency of lower-extremity revascularization should be monitored with a surveillance program.
First line of therapy for patients with lifestyle-limiting claudication is a supervised 12-week exercise program and medication. Revascularization should be considered if these therapies fail.
Death from a cardiac cause has a relative risk of 3 to 6 in patients with peripheral vascular disease.
PAD includes a range of arterial syndromes that are caused by atherosclerotic obstruction of the lower-extremity arteries.
History and exam
Key diagnostic factors
- intermittent claudication
- thigh or buttock pain with walking that is relieved with rest
- diminished or absent pulse
- sudden onset of severe leg pain accompanied by numbness, weakness, pale and cold leg
Other diagnostic factors
- erectile dysfunction
- leg pain at rest
- nonhealing 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
- elevated C-reactive protein (CRP)
- age >40 years
- history of coronary artery disease/cerebrovascular disease
- low levels of exercise
- vasculitis/inflammatory conditions
- arterial fibrodysplasia
1st investigations to order
- ankle-brachial index (ABI)
Investigations to consider
- toe-brachial index (TBI)
- segmental pressure examination
- pulse volume recording
- duplex ultrasound
- continuous wave Doppler ultrasound
- exercise ankle-brachial index (ABI)
- catheter angiography
- CT angiogram
- magnetic resonance angiography (MRA)
acute limb ischemia
claudication (not lifestyle-limiting)
chronic severe limb ischemia (critical limb ischemia)
- Spinal stenosis
- Venous claudication
- ACR Appropriateness Criteria: lower extremity arterial claudication - imaging assessment for revascularization
- Canadian Cardiovascular Society guidelines for peripheral arterial disease
Peripheral arterial diseaseMore Patient leaflets
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