Peripheral Vascular Disease

Peripheral vascular disease is a broad term, but the high-stakes arterial problem is lower-extremity peripheral arterial disease (PAD): atherosclerotic narrowing or occlusion of arteries supplying the legs. The narrowed artery may deliver enough blood while the patient is resting. Once the calf or thigh muscles begin working, oxygen demand rises but flow cannot increase adequately. The resulting exertional muscle pain is intermittent claudication. Claudication is usually reproducible: a similar walking distance produces discomfort in the same muscle group, and rest relieves it within minutes. The location helps localize disease. Buttock or thigh claudication suggests more proximal obstruction; calf pain is common with femoropopliteal disease. As perfusion worsens, the limb can no longer meet metabolic demand at rest. Ischaemic rest pain, a non-healing wound, or gangrene indicates chronic limb-threatening ischaemia (CLTI). Rest pain often affects the forefoot or toes and may worsen at night. Letting the leg hang down can temporarily improve symptoms because gravity augments distal flow; it does not correct the obstruction. PAD is not merely a leg disorder. It identifies established atherosclerotic cardiovascular disease, so treatment is secondary...