Peripheral Artery Disease is a circulatory condition in which arteries supplying the limbs, most commonly the legs, become narrowed or blocked, usually because of atherosclerotic disease. It reduces blood flow to tissues distal to the affected arterial segment and can cause symptoms ranging from exertional leg discomfort to chronic limb-threatening ischaemia. The disease is part of systemic arterial disease rather than an isolated problem of the legs, so its presence is associated with increased risk of cardiovascular and cerebrovascular events. Although atherosclerosis is the most common cause, other arterial disorders can occasionally produce similar limb ischaemia.
A classic symptom of Peripheral Artery Disease is intermittent claudication, in which aching, cramping, heaviness or fatigue develops in a limb during walking and improves with rest. The location of symptoms can help identify the arterial level involved, although presentation varies. Some people have no typical symptoms because they limit activity, attribute discomfort to ageing or have neuropathy that reduces pain perception. More advanced disease can produce rest pain, particularly in the foot, non-healing wounds, tissue loss and gangrene. These manifestations indicate progressively impaired perfusion and require increasingly urgent assessment.
Risk factors for Peripheral Artery Disease substantially overlap with those for systemic Atherosclerosis. Tobacco exposure is particularly important, while diabetes, hypertension, elevated cholesterol, chronic kidney disease and increasing age also contribute. A family history of premature cardiovascular disease can increase risk. Because the disease reflects systemic vascular pathology, people with peripheral arterial disease can have simultaneous coronary or cerebrovascular atherosclerosis. Cardiovascular risk assessment and management are therefore fundamental components of treatment even when the presenting complaint concerns the legs.
Diagnosis commonly begins with history and examination, including assessment of peripheral pulses, skin condition, temperature and wounds. The ankle-brachial pressure index compares ankle and arm systolic pressures and can identify reduced arterial perfusion, although interpretation can be complicated by arterial calcification, particularly in diabetes or chronic kidney disease. Doppler ultrasound can evaluate blood flow and stenosis, while computed tomography or magnetic resonance angiography can provide more detailed anatomical mapping when intervention is being considered. Invasive catheter angiography is generally reserved for selected circumstances, particularly when revascularisation is planned.
Management of Peripheral Artery Disease includes aggressive cardiovascular-risk reduction and treatment of limb symptoms. Smoking cessation is particularly important, while lipid-lowering therapy, appropriate blood-pressure control and diabetes management reduce cardiovascular risk. Supervised exercise therapy can improve walking capacity and functional performance in people with intermittent claudication by promoting physiological adaptation and improving exercise tolerance. Antiplatelet or other antithrombotic treatment may be indicated according to the clinical situation. Medication should be selected according to overall cardiovascular and bleeding risk rather than simply the presence of leg symptoms.
Revascularisation may be considered when symptoms remain significantly limiting despite appropriate conservative treatment or when there is threatened limb viability. Endovascular techniques can include balloon angioplasty, stenting or other catheter-based approaches, while surgical bypass can create an alternative route around a severely diseased arterial segment. Acute limb ischaemia is a different and more urgent presentation in which arterial flow becomes suddenly compromised, potentially because of thrombosis or embolism. It can cause pain, pallor, pulselessness, sensory loss, weakness and coldness and requires emergency assessment because prolonged severe ischaemia can cause irreversible tissue injury.
Peripheral Artery Disease can be underdiagnosed because patients may not report classic claudication. Reduced walking activity, coexisting arthritis or spinal disease and atypical symptoms can obscure the diagnosis. Foot care is particularly important in people with diabetes because neuropathy can reduce pain sensation while poor arterial perfusion impairs wound healing. A small injury can consequently progress to ulceration or infection. Multidisciplinary management may involve vascular specialists, podiatry, diabetes care and wound management when advanced disease is present.
A common misconception is that Peripheral Artery Disease is simply a local leg problem. In reality, it is an important marker of systemic atherosclerotic burden and elevated cardiovascular risk. Another misconception is that absence of pain excludes disease; many affected people are asymptomatic or have atypical symptoms. Peripheral arterial disease should also be distinguished from venous disease, musculoskeletal pain and neurological conditions because these can produce superficially similar leg symptoms through entirely different mechanisms.
