Synopsis
Diagnose lower-limb PAD, distinguish intermittent claudication from limb-threatening ischaemia, deliver cardiovascular prevention and activate urgent revascularisation pathways.
- Suspect PAD with exertional calf, thigh or buttock pain relieved by rest, non-healing leg/foot wounds, rest pain, gangrene, absent pulses or before leg compression/intervention.
- Measure ABPI with Doppler after supine rest: use the highest ankle artery pressure in each leg divided by the highest brachial pressure.
- ABPI 0.90 or lower supports PAD, but a normal or high ABPI does not exclude disease in diabetes or CKD because calcified vessels may be incompressible.
Key red flags
Ischaemic rest pain, non-healing ulcer for at least 2 weeks or gangrene. Haemodynamic support includes ankle pressure below 50 mmHg, toe pressure below 30 mmHg or transcutaneous oxygen below 30 mmHg, interpreted with the whole clinical picture.
Investigation priorities
Confirm haemodynamic PAD and document baseline severity.
First-line anatomical imaging when revascularisation is being considered.
Management branches
Exertional limb symptoms without rest pain, ulcer, gangrene or acute neurological deficit.
- Offer smoking cessation, supervised exercise, healthy weight/diet support and management of BP and diabetes; give high-intensity statin and appropriate antithrombotic secondary prevention.
- Offer a supervised programme, aiming for about 2 hours of supervised exercise weekly for 3 months and exercise to maximal claudication pain when safe.
Key medicines
Clopidogrel75 mg orally once daily.
Atorvastatin80 mg orally once daily for secondary prevention; use a lower dose when interactions, high adverse-effect risk or patient preference make 80 mg unsuitable.