Diagnosis (practical)
- Typical symptoms: exertional calf/thigh/buttock pain relieved by rest; reduced walking distance; non-healing ulcers; rest pain.
- ABPI: <0.9 supports PAD; <0.5 suggests severe disease; >1.3 may be falsely high (diabetes/CKD) → toe pressures/specialist assessment.
- Exam: pulses, cap refill, temperature gradient, trophic changes, ulcers; assess feet carefully in diabetes.
Management (high-yield checklist)
- Supervised exercise programme for intermittent claudication (core symptom treatment).
- Antiplatelet: commonly clopidogrel 75 mg OD unless contraindicated (follow local formulary).
- Statin: high-intensity (e.g., atorvastatin 80 mg OD) unless contraindicated.
- Risk reduction: smoking cessation, BP and diabetes optimisation, weight/activity support.
When to refer (don’t miss limb threat)
- Urgent vascular same-day: acute limb ischaemia, rest pain, tissue loss/ulceration, gangrene, rapidly progressive symptoms.
- Routine referral: lifestyle-limiting claudication despite optimal medical therapy + supervised exercise, or diagnostic uncertainty.
Frequently asked questions
Can PAD exist with a normal ABPI?
Yes — ABPI can be falsely normal/high in calcified vessels (diabetes/CKD). If symptoms are convincing, consider toe pressures or vascular review.
Transparency
This page is an educational, clinician-written summary of publicly available NICE guidance intended for trained healthcare professionals. It uses original wording (not copied text) and should be used alongside the full NICE source, local pathways, and clinical judgement. Doses provided are for general reference; always check the BNF/SPC.