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Peripheral artery disease
Peripheral artery disease is diagnosed by an ankle–brachial index (ABI) of 0.90 or less; the basic treatment is supervised walking and full cardiovascular prevention, and revascularisation is reserved for limiting claudication despite treatment or for critical ischaemia.
Why it matters in the exam
Questions test the diagnosis (ABI 0.90 or less; above 1.40 the arteries are non-compressible — in diabetes and kidney failure — and a toe–brachial index is measured instead), the distinction between intermittent claudication (calf pain on walking that settles on standing still) and pseudo-claudication from spinal stenosis (relieved by sitting or bending forward), and Leriche syndrome — buttock claudication, impotence and weak femoral pulses.
Treatment is also asked: stopping smoking, a high-intensity statin, an antiplatelet drug (clopidogrel or aspirin), blood pressure and glucose control, a supervised walking programme, and cilostazol to improve walking distance — forbidden in heart failure. In high-risk patients, rivaroxaban 2.5 mg twice daily combined with aspirin reduced cardiac and limb events, including amputations. Beta-blockers are not contraindicated in this disease.
An emergency that is asked is acute limb ischaemia: pain, pallor, pulselessness, paraesthesia, paralysis and coldness — from an embolus (usually from atrial fibrillation) or from thrombosis on atherosclerosis. Treatment: heparin at once and urgent revascularisation, because paralysis and loss of sensation signal an immediately threatened limb.
Key points
- Diagnosis: ABI 0.90 or less; above 1.40 — toe–brachial index.
- Basic treatment: stop smoking, statin, antiplatelet, supervised walking.
- Rivaroxaban 2.5 mg twice daily with aspirin reduces events and amputations at high risk.
- Revascularisation: limiting claudication despite treatment, or critical ischaemia.
- Acute ischaemia: heparin at once and urgent revascularisation.
Summary table
| Item | The rule | Details | Trap |
|---|---|---|---|
| Diagnosis | ABI 0.90 or less | Above 1.40 — non-compressible arteries; measure a toe–brachial index | Spinal pseudo-claudication eases on sitting |
| Intermittent claudication | Calf pain on walking, relieved by standing | Supervised walking first of all | Cilostazol is forbidden in heart failure |
| Prevention | Stop smoking, high-intensity statin, antiplatelet, glucose and blood pressure control | Rivaroxaban 2.5 mg twice daily with aspirin at high risk | Beta-blockers are allowed |
| Chronic limb-threatening ischaemia | Rest pain, ulcers, gangrene | Revascularisation (endovascular or bypass) | Risk of amputation |
| Acute ischaemia | Pain, pallor, pulselessness, paraesthesia, paralysis, coldness | Heparin at once and urgent revascularisation | Look for atrial fibrillation as the source |
| Leriche | Buttock claudication, impotence, weak femoral pulses | Aorto-iliac occlusion | — |
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Sources
- ESC Guidelines for the management of peripheral arterial and aortic diseases, 2024 — Lower-extremity arterial disease and acute limb ischaemia
- Harrison's Principles of Internal Medicine, 21st edition (2022) — Arterial Diseases of the Extremities
Sources are given for further reading; the text is written afresh and not copied from them.
Reviewed by the Examqo AI Professor · 2026-11-02. The text may contain errors; when in doubt, check the source.