Peripheral Artery Disease (PAD)

Creator: Progress Note
Published: 2026-08-28
Keywords: peripheral artery disease, peripheral artery disease symptoms, intermittent claudication, ankle-brachial index, critical limb ischemia, PAD treatment

bolt The 60-second version

check_circlePAD is atherosclerosis of the limb arteries, usually the legs.
check_circleIntermittent claudication — exertional leg pain relieved by rest — is the hallmark.
check_circleThe ankle-brachial index (ABI) is the key diagnostic test; a value below 0.9 indicates PAD.
check_circleCritical limb ischemia causes rest pain, ulcers, and gangrene.
check_circleManagement includes risk-factor control, antiplatelets, statins, exercise, and revascularization.

Presentation

The classic symptom of peripheral artery disease is intermittent claudication: cramping pain in the calf, thigh, or buttock brought on by walking and relieved by rest, reflecting demand outstripping a fixed arterial supply. Examination may reveal diminished pulses, cool skin, hair loss, and delayed capillary refill. Many patients are asymptomatic, and PAD is a strong marker of systemic atherosclerosis and cardiovascular risk.

Diagnosis

The ankle-brachial index (ABI) — the ratio of ankle to brachial systolic blood pressure — is the primary diagnostic test; a value of 0.90 or below indicates PAD, and lower values indicate more severe disease. Very high, non-compressible values can occur with calcified vessels in diabetes. Duplex ultrasound and angiography define anatomy when revascularization is considered.

Critical Limb Ischemia

Critical (chronic) limb-threatening ischemia is advanced PAD with rest pain (often in the forefoot at night), non-healing ulcers, or gangrene, reflecting inadequate perfusion even at rest. It threatens the limb and requires prompt vascular evaluation for revascularization. Acute limb ischemia, by contrast, is a sudden occlusion presenting with the "six Ps" and is a surgical emergency.

Management

Management combines aggressive cardiovascular risk reduction — smoking cessation, a statin, blood pressure and diabetes control, and antiplatelet therapy — with a supervised exercise program, which improves walking distance. Cilostazol can improve claudication symptoms. Revascularization by angioplasty, stenting, or bypass is reserved for lifestyle-limiting claudication despite therapy or for critical limb ischemia.

Frequently asked questions

What is intermittent claudication?expand_more

Intermittent claudication is cramping pain in the leg muscles — typically the calf — brought on by walking and relieved by rest. It is the hallmark symptom of peripheral artery disease and occurs because narrowed arteries cannot meet the increased oxygen demand of exercising muscle.

How is peripheral artery disease diagnosed?expand_more

The ankle-brachial index (ABI), which compares blood pressure at the ankle and the arm, is the primary test. An ABI of 0.90 or lower indicates peripheral artery disease. Duplex ultrasound or angiography is used to define the anatomy when a procedure is being considered.

What is critical limb ischemia?expand_more

Critical limb-threatening ischemia is advanced peripheral artery disease with rest pain, non-healing ulcers, or gangrene, indicating that blood flow is inadequate even at rest. It threatens the limb and requires urgent vascular evaluation for revascularization.

How is peripheral artery disease treated?expand_more

Treatment combines cardiovascular risk reduction — smoking cessation, statins, antiplatelet therapy, and blood pressure and diabetes control — with a supervised exercise program. Cilostazol can help symptoms, and revascularization is used for severe, lifestyle-limiting disease or critical limb ischemia.

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