From the Guidelines
Patients with peripheral arterial disease (PAD) in the lower extremities typically present with intermittent claudication, which is muscle pain or cramping during walking that resolves with rest, as noted in the most recent study 1. This classic symptom occurs because narrowed arteries cannot deliver sufficient blood flow to meet the increased oxygen demands of exercising muscles. Many patients also experience pain at rest, particularly at night, which may improve by hanging the leg over the bed to increase blood flow via gravity.
Key Presentation Features
- Intermittent claudication: muscle pain or cramping during walking that resolves with rest
- Pain at rest, particularly at night
- Diminished or absent pulses in the affected limbs
- Cool skin temperature
- Pallor on elevation
- Dependent rubor
- Delayed capillary refill In advanced cases, patients may develop tissue loss with non-healing ulcers, typically on the toes, feet, or ankles, and gangrene in severe cases.
Risk Factors and Associated Conditions
- Smoking
- Diabetes
- Hypertension
- Hyperlipidemia
- Advanced age Some patients, particularly those with diabetes, may be asymptomatic due to concurrent neuropathy masking pain signals. The "6 Ps" of acute limb ischemia may be present in severe cases: pain, pallor, pulselessness, paresthesia, paralysis, and poikilothermia (cool temperature), as discussed in 1 and 1.
Clinical Implications
The clinical presentation of PAD is a significant predictor of cardiovascular morbidity and mortality, with smokers and diabetics at particularly high risk for disease progression and complications, as highlighted in 1.
From the Research
Presentation of Peripheral Arterial Disease (PAD) in the Lower Extremities
A person with peripheral arterial disease (PAD) in the lower extremities typically presents with:
- Intermittent claudication, characterized by leg muscle pain, cramping, and fatigue brought on by ambulation or exercise, and relieved by rest 2, 3, 4, 5
- Pain in the calf, thigh, or buttock that is elicited by exertion and relieved with a few minutes of rest 5
- Symptoms of ischemic rest pain, ulceration, or gangrene may be present at the most advanced stage of the disease 4, 5
Common Symptoms and Signs
- Reproduducible, painful aching or cramping in muscle groups of the leg caused by walking and relieved by rest 3
- Incapacitating claudication that interferes with work or lifestyle 6
- Limb salvage in persons with limb-threatening ischemia as manifested by rest pain, nonhealing ulcers, and/or infection or gangrene 6
- Vasculogenic impotence 6