Peripheral arterial disease

Also known as PAD · Intermittent claudication · Peripheral vascular disease

GP-fellowship guide to peripheral arterial disease: the 230 million people affected worldwide, claudication and its mimics, ABI thresholds for diagnosis and severity, smoking cessation and supervised exercise as the highest-yield interventions, guideline-directed medical therapy, when to refer for revascularisation, the diabetic foot as a special emergency, critical limb ischaemia criteria from TAMARIS, and the coronary-equivalent prevention opportunity.

medium3 referencesUpdated 21 Aug 20264 min readVerification in progress

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Key points

Peripheral arterial disease affects approximately 230 million people worldwide, driven by ageing, smoking, diabetes, hypertension and dyslipidaemia — and finding it should trigger the same aggressive prevention you would give after a myocardial infarction.^[1]
Ankle-brachial index (ABI) of 0.9 or less diagnoses PAD; below 0.5 signals severe disease; above 1.4 suggests non-compressible diabetic vessels and needs toe pressure instead.^[1]
Guideline-directed medical therapy (antithrombotic, lipid-lowering, glucose-lowering, antihypertensive) plus exercise therapies improve both cardiovascular and limb outcomes; revascularisation is for limb-threatening ischaemia or severe functional impairment that does not improve with exercise.^[1]
Supervised exercise works: light-to-moderate intensity improved maximal walking distance by 223 m (95% CI 174–271) in meta-analysis; vigorous walking gave the largest gains (272 m).^[3]

Overview

Peripheral arterial disease is atherosclerosis of the arteries supplying the lower limbs. It affects approximately 230 million people worldwide and is growing with population ageing, smoking, diabetes, hypertension and dyslipidaemia.^[1] PAD is a coronary-equivalent risk state: finding it means the patient's whole arterial tree is diseased, and cardiovascular prevention becomes the primary intervention alongside limb-specific care.^[1]

References3Show

[1]Aboyans V, Canonico ME, Chastaingt L, et al. Peripheral artery disease Nat Rev Dis Primers, 2025.PMID 40968271
[2]Belch J, Hiatt WR, Baumgartner I, et al. Effect of fibroblast growth factor NV1FGF on amputation and death: a randomised placebo-controlled trial of gene therapy in critical limb ischaemia Lancet, 2011.PMID 21621834
[3]Fassora M, Calanca L, Jaques C, et al. Intensity-dependent effects of exercise therapy on walking performance and aerobic fitness in symptomatic patients with lower-extremity peripheral artery disease: A systematic review and meta-analysis Vasc Med, 2022.PMID 34579581