CardiologyTier 2Disease (DEADMAN)

Peripheral arterial disease

Description

Atherosclerotic narrowing of the arteries supplying the limbs (predominantly lower limb) - a marker of systemic atherosclerosis with cardiovascular risk comparable to established coronary disease

Shares risk factors with coronary disease - smoking (the strongest modifiable risk factor for PAD specifically), diabetes, hypertension, dyslipidaemia, age; prevalence rises steeply with age

The same atherosclerotic process as coronary/cerebrovascular disease, affecting lower limb arteries (aortoiliac, femoropopliteal, or below-knee segments) - reduced blood flow becomes symptomatic once demand (exercise) exceeds supply

Intermittent claudication - reproducible exertional muscle pain (calf most common), relieved by rest - the classic symptom, though many patients are asymptomatic or have atypical symptoms
ABI <0.9 supports the diagnosis (see ankle-brachial index); imaging (duplex, CTA, MRA) for anatomical detail when intervention is being considered
Critical limb ischaemia - rest pain, ulceration, or gangrene - a limb-threatening stage requiring urgent vascular referral

Risk factor modification - smoking cessation (the single most impactful intervention), statin, antiplatelet, BP/glucose control - as for any atherosclerotic disease, given the systemic cardiovascular risk
Supervised exercise therapy - first-line for claudication, comparable efficacy to revascularisation for symptom improvement in many patients
Revascularisation (angioplasty/stenting or surgical bypass) for lifestyle-limiting claudication refractory to conservative measures, or for critical limb ischaemia
Beta-blockers are not contraindicated in PAD and should be used when otherwise indicated (e.g. concurrent coronary disease) - avoiding them is now considered outdated dogma

Coronary artery disease, cerebrovascular disease (shared atherosclerotic burden), diabetes, critical limb ischaemia, erectile dysfunction (shared vascular risk factor profile)

PAD is as strong a marker of overall cardiovascular risk as established coronary disease - patients are more likely to die of a cardiac or cerebrovascular event than to lose a limb, underscoring the priority of systemic risk factor management alongside limb-focused treatment

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