Peripheral artery disease is narrowing of the leg arteries by atherosclerosis, which limits blood flow to the muscles during exercise. It shares risk factors with heart disease, such as smoking and diabetes, and signals a high risk of heart attack and stroke.
Key symptoms
- Cramping calf pain on walking that eases with rest (claudication)
- Leg pain at rest, worse lying flat and better with the leg hanging down
- Slow-healing foot or toe wounds
- Cold or numb feet; erectile dysfunction
What you find on exam
- Weak or absent foot pulses
- Cool, shiny, hairless skin and thick nails
- Pallor when the leg is raised and redness when it hangs down
- Femoral bruits; ulcers on the toes or heels
Tests
- Ankle-brachial index: 0.90 or less confirms PAD
- Toe-brachial index if arteries are stiff (ankle-brachial index over 1.40)
- Duplex ultrasound to locate the narrowing
- Lipid panel, HbA1c and kidney function
Treatment basics
- Stop smoking; supervised walking program
- Antiplatelet therapy with aspirin or clopidogrel
- High-intensity statin; control blood pressure and diabetes
- Cilostazol for claudication if there is no heart failure
- Revascularization for disabling symptoms or critical limb ischemia
Red flags
- Sudden cold, pale, painful, pulseless leg (acute limb ischemia)
- Pain at rest or gangrene
- Nonhealing wound with infection
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Sources: NCCPA PANCE Content Blueprint; NBOME COMLEX-USA clinical presentations; AAMC Core Entrustable Professional Activities (Core EPAs). Written by Making Synapses. Making Synapses is not affiliated with these organizations.