GPAtlas🧭 When to suspect
Peripheral arterial disease (PAD) is atherosclerotic narrowing of the arteries supplying the limbs, almost always the lower limbs. Its importance in primary care is twofold: it is a powerful marker of systemic atherosclerosis – most people with PAD die of myocardial infarction or stroke, not limb loss – and it spans a spectrum from silent disease to a limb-threatening emergency.
Around 70–90% of people with a reduced ankle–brachial pressure index (ABPI) have no symptoms, so actively suspect PAD in anyone with cardiovascular risk factors – particularly smokers (the strongest modifiable risk factor) and people with diabetes, non-healing foot wounds, or unexplained leg pain. Other risks include hypertension, hyperlipidaemia, chronic kidney disease, age over 60, established cardiovascular disease, and a family history of premature vascular disease.
| Clinical pattern | Hallmark features | Urgency |
|---|---|---|
| Intermittent claudication | Cramping pain in the calf, thigh or buttock brought on by walking and relieved by rest (usually within ~5 minutes) | Routine – risk-factor modification and supervised exercise |
| Chronic limb-threatening ischaemia (CLTI) | Ischaemic rest pain (worse at night, eased by hanging the leg down), ulceration or gangrene | Urgent vascular referral |
| Acute limb ischaemia (ALI) | Sudden loss of perfusion – the 6 Ps (pain, pallor, pulselessness, paraesthesia, paralysis, perishingly cold) | Emergency – 999 / immediate vascular assessment |
NICE advises assessing for PAD in people with symptoms suggestive of it, or who have diabetes, non-healing leg or foot wounds, or unexplained leg pain, and in those being considered for interventions to the leg or foot, or who need compression hosiery.
Source: NICE CG147
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