Peripheral Arterial Disease (PAD)

🔍 When to Suspect

Intermittent claudication: cramping leg pain on exercise, relieved by rest, particularly in smokers or people with diabetes; may present with rest pain or ulcers

From the full topic in The Ocean Library: Peripheral Arterial Disease (PAD)

🧭 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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