Peripheral arterial disease

This article provides an overview of peripheral arterial disease (PAD) of the lower limb including its epidemiology, risk factors, diagnosis, and current management approaches. PAD is most commonly the result of atherosclerosis. It can be thought of as a continuum of disease from asymptomatic through to chronic limb-threatening ischaemia (CLTI). Most patients are asymptomatic. Intermittent claudication is the most common symptom. Key risk factors for PAD are smoking, age, male sex, hypertension, chronic kidney disease (CKD), and diabetes mellitus. The diagnosis of PAD tends to be a marker of atherosclerosis in other arterial beds, putting these patients at high risk of adverse cardiovascular outcomes. Diagnosis of PAD is primarily achieved through history and examination with the aid of non-invasive bedside tests. Imaging is essential when planning revascularization to establish the anatomical patterns and severity of disease. Management of PAD is centred around (1) reduction of cardiovascular morbidity and mortality and (2) management of lower limb symptoms to improve quality of life and protect the limb. Treatment tends to be conservative in the early stages. Patients with CLTI require lower limb revascularization using an endovascular, open surgical, or hybrid approach. In some patients, primary amputation is the best option.