Feature Article

Peripheral arterial disease: a systematic management strategy

Aniket Pradhan, Kurian J Mylankal, Robert Fitridge



Peripheral arterial disease affects over 200 million people worldwide. A proportion of patients are asymptomatic, whereas others experience exertional leg pain or symptoms of critical limb ischaemia. Concomitant atherosclerotic disease progression in other vital vascular territories raises the risk of myocardial infarction and stroke in this patient cohort. A systematic management strategy is crucial and must address risk factors for atherosclerosis while aiming to improve mobility and quality of life and prevent major lower limb amputation.

Key Points

  • Although a proportion of patients with peripheral arterial disease (PAD) are asymptomatic, others experience intermittent claudication (IC) or symptoms of critical limb ischaemia (CLI).
  • Patients with PAD are at a higher risk of cardiovascular and cerebrovascular morbidity and mortality.
  • Measurement of the ankle brachial index is a simple, noninvasive test for quantifying vascular compromise to the lower limb extremities.
  • Management of atherosclerotic risk factors is crucial in all patients with PAD.
  • In patients with IC, revascularisation should be reserved for those with severe limitation to mobility or who have failed medical management.
  • In patients with CLI, revascularisation aims to prevent limb loss, resolve rest pain and heal ischaemic ulceration or gangrene.

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