Peripheral Artery Disease (PAD)

•RCT evidence— Same secondary-prevention pharmacology as ASCVD

What it is

PAD is atherosclerosis primarily affecting the iliac, femoral, and infrapopliteal arteries. Spectrum from asymptomatic (most common), through intermittent claudication, to chronic limb-threatening ischaemia with rest pain, non-healing wounds, or gangrene.

Why it matters beyond limbs

PAD is a marker of systemic atherosclerosis. Adults with PAD have:

• ~3× the risk of MI and stroke compared to age-matched controls.
• 2–5-year mortality often higher than many cancers.
• High prevalence of concomitant coronary and carotid disease.

Screening (ABI)

The ankle-brachial index is a simple Doppler measurement comparing systolic BP at the ankle vs the arm:

• >1.30: non-compressible (calcified) — common in diabetes; needs toe-brachial index instead.
• 0.91–1.30: normal.
• 0.71–0.90: mild PAD.
• 0.41–0.70: moderate.
• ≤0.40: severe.

Treatment

• Smoking cessation: single biggest modifier.
• Antiplatelet (aspirin or clopidogrel) + DOAC low-dose (rivaroxaban 2.5 mg BID) in selected high-risk PAD per COMPASS.
• High-intensity statin + ezetimibe; PCSK9i for residual risk.
• BP control.
• Diabetes management with cardiovascular benefit drugs.
• Supervised exercise (best evidence for symptom improvement).
• Cilostazol for symptomatic claudication.
• Revascularisation (endovascular or surgical) for limb-threatening ischaemia or disabling claudication.

Related entries

Cardiovascular disease, Stroke, Statins, Type 2 diabetes.