Peripheral artery disease (PAD)
Peripheral artery disease is atherosclerotic narrowing of the limb arteries, most often causing exertional claudication and, when advanced, chronic limb-threatening ischemia. It is a strong marker of systemic atherosclerosis, diagnosed by the ankle-brachial index, and managed with aggressive risk-factor control, antiplatelet therapy, exercise, and revascularization for severe disease.
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What this article covers
- Overview
Definition: peripheral artery disease (PAD) is atherosclerotic stenosis or occlusion of the peripheral (usually lower-limb) arteries, reducing distal perfusion.
- Epidemiology
Common, rising with age, and strongly linked to smoking and diabetes.
- Risk factors
Smoking and diabetes (the strongest risk factors).
- Pathophysiology
Atherosclerotic stenosis: plaque narrows limb arteries, limiting flow reserve during exertion (claudication).
- Clinical features
Intermittent claudication: reproducible cramping muscle pain with walking, relieved by rest.
- Differential diagnosis
Neurogenic claudication (spinal stenosis): positional leg pain relieved by leaning forward, distinguished from PAD by preserved pulses, a normal ankle-brachial index, and symptom relief with spinal flexion rather than rest.
- Diagnosis
Establish with the ankle-brachial index, confirmed and localized by further vascular imaging: the diagnostic basis is an ankle-brachial index of 0.90 or less at rest (with exercise testing when…
- Management
First-line, aggressive risk-factor modification and antithrombotic therapy: Smoking cessation, with blood pressure and diabetes control.
- Complications
Chronic limb-threatening ischemia, ulceration, and amputation.
- Prognosis
Limb prognosis is good for claudication with risk-factor control.
- Prevention
Smoking cessation (the single most important measure).
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