Table of Contents
Learn the focussed examination too…
The peripheral arterial focussed examination covered here!
Clinical features
Acute limb ischaemia
- Occurs due to thrombus (acute on chronic) or emboli
- 6 P’s: Pale, Pulseless, Paraesthesia, Paralysis, Pain, Perishingly cold
Intermittent claudication
- Calf pain on exertion which is relieved by rest (check claudication distance)
Critical ischaemia
- Chronic rest pain (often at night, relieved by hanging legs over bed)
- Tissue loss (e.g. arterial ulcers, gangrene)
Investigations
- Ankle-brachial pressure index
- <0.9 = intermittent claudication
- <0.6 = rest pain
- <0.3 = critical ischaemia
- NB: ABPI may be falsely elevated in patients with calcified arteries.
- Imaging
- Duplex ultrasound (first line imaging)
- MR or CT angiography (second line imaging, MR preferred but CT more widely available)
- Catheter angiography (third line)
- Bloods: lipid levels, fasting glucose, FBC (rule out anaemia), U&Es (to check renal function prior to contrast), coagulation screen
- ECG: to look for AF as a cause of emboli
Management
- Risk factor control
- Antiplatelet therapy (aspirin or clopidogrel)
- Lipid lowering therapy (statin)
- Smoking cessation
- Diet, weight management and exercise
- BP and diabetes control
- Supervised exercise regimen (for intermittent claudication)
- Naftidrofuryl oxalate (for intermittent claudication) – rarely successful
- Revascularisation for acute ischaemia
- Percutaneous catheter-directed thrombolytic therapy
- Percutaneous transluminal angioplasty (stent)
- Surgical embolectomy
- Revascularisation for chronic ischaemia
- Percutaneous transluminal angioplasty (stent) – if possible (i.e. short segment, not at knee joint, good run-off)
- Vascular bypass grafting
- Debridement/amputation for gangrene or non-viable limbs
Reference: NICE ‘CG147 Peripheral arterial disease: diagnosis and management’ 2020
Vascular bypass procedures

Some questions
What are the risk factors for peripheral arterial disease?
Oops! This section is restricted to members.
What is Leriche syndrome?
Oops! This section is restricted to members.