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Peripheral artery disease

Nature Reviews Disease Primers volume 11, Article number: 68 (2025) Cite this article

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Abstract

Peripheral artery disease (PAD) is characterized by blockage of the arteries that supply the lower extremities, often occurring as a result of atherosclerosis and thrombosis. PAD affects approximately 230 million people worldwide, with a growing prevalence owing to population ageing and concomitant cardiovascular risk factors, including smoking, diabetes mellitus, hypertension and dyslipidaemia. Patients with PAD have an increased risk of major cardiovascular and limb events, and substantially poorer walking performance compared with those without PAD. The screening and identification of PAD involves clinical and imaging assessments of disease extent and severity and stratification of individual risk to ensure appropriate management. Patients with PAD should be treated with guideline-directed medical therapy (GDMT), including antithrombotic, lipid-lowering, glucose-lowering and anti-hypertensive therapies, and exercise therapies that aim to improve function as well as cardiovascular and limb outcomes. For patients with compromised limb viability, such as acute and chronic limb-threatening ischaemia, or severe functional impairment that does not improve with exercise training, lower extremity revascularization is recommended. Given the complexity of PAD management, a multidisciplinary vascular team is required to achieve the best individualized treatment. Further research efforts should focus on reducing ischaemic events and health disparities and on optimizing the implementation of GDMT and exercise therapy, as well as improving the quality of life in patients with PAD.

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Fig. 1: Atherosclerosis and microvascular dysfunction in PAD.
Fig. 2: Endothelial and microvascular dysfunction at the cellular level in PAD.
Fig. 3: Peripheral artery disease classification and risk of limb loss according to clinical presentation.
Fig. 4: Ankle–brachial index and toe–brachial index assessment of peripheral artery disease.
Fig. 5: Multimodality evaluation of peripheral artery disease at first assessment.
Fig. 6: Multimodality evaluation of peripheral artery disease at second assessment.
Fig. 7: Treatment algorithm in patients with peripheral artery disease according to clinical presentation.

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Author notes

  1. These authors contributed equally: Victor Aboyans, Mario Enrico Canonico.

Authors and Affiliations

  1. Department of Cardiology, Dupuytren University Hospital, Limoges, France

    Victor Aboyans

  2. EpiMaCT, Limoges University, Limoges, France

    Victor Aboyans & Lucie Chastaingt

  3. CPC Clinical Research, Aurora, CO, USA

    Mario Enrico Canonico & Marc P. Bonaca

  4. Department of Medicine, University of Colorado, Aurora, CO, USA

    Mario Enrico Canonico & Marc P. Bonaca

  5. Department of Vascular Surgery & Medicine, Dupuytren-2 University Hospital, Limoges, France

    Lucie Chastaingt

  6. Population Health Research Institute, Hamilton Health Sciences, Department of Medicine, McMaster University, Hamilton, Ontario, Canada

    Sonia S. Anand

  7. Division of Angiology, Department of Internal Medicine, Medical University, Graz, Austria

    Marianne Brodmann

  8. University of Bordeaux, INSERM, Biology of Cardiovascular Diseases, Pessac, France

    Thierry Couffinhal

  9. Division of Preventive Medicine, University of California at San Diego, San Diego, CA, USA

    Michael H. Criqui

  10. Department of Vascular Medicine, Vascular Surgery–Angiology–Endovascular Therapy, University of Hamburg-Eppendorf, Hamburg, Germany

    Eike Sebastian Debus

  11. Angiology Department, Lausanne University Hospital, University of Lausanne, Lausanne, Switzerland

    Lucia Mazzolai

  12. Northwestern University Feinberg School of Medicine, Chicago, IL, USA

    Mary M. McDermott

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Contributions

Introduction (V.A., M.E.C., L.C. and M.P.B.); Epidemiology (V.A., M.E.C., L.C. and M.P.B.); Mechanisms/pathophysiology (V.A., M.E.C., S.S.A. and M.P.B.); Diagnosis, screening and prevention (V.A., M.E.C., S.S.A., M.B., T.C. and M.P.B.); Management (V.A., M.E.C., M.B., T.C., M.H.C. and M.P.B.); Quality of life (V.A., M.E.C., M.H.C., E.S.D., L.M., M.M.M. and M.P.B.); Outlook (V.A., M.E.C., E.S.D., L.M., M.M.M. and M.P.B.); overview of the Primer (V.A.).

Corresponding author

Correspondence to Victor Aboyans.

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Competing interests

V.A. has received, over the past 3 years, honoraria from: Amarin, Amgen, AstraZeneca, Bayer, Boehringer-Ingelheim and Novo-Nordisk. M.E.C. and M.P.B. receive salary support from CPC, a non-profit academic research organization affiliated with the University of Colorado that receives or has received research grant and/or consulting funding between August 2021 and the present from: Abbott Laboratories, Agios Pharmaceuticals, Inc., Alexion Pharma, Alnylam Pharmaceuticals, Inc., Amgen, Inc., Angionetics, Inc., Anthos Therapeutics, Array BioPharma, Inc., AstraZeneca and affiliates, Atentiv LLC, Audentes Therapeutics, Inc., Bayer and affiliates, Bristol-Meyers Squibb, Cambrian Biopharma, Inc., Cardiol Therapeutics, Inc., CellResearch Corp., Cleerly, Inc., Cook Regentec LLC, CSL Behring LLC, Eidos Therapeutics, Inc., EP Trading Co. Ltd, Epizon Pharma, Inc., Esperion Therapeutics, Inc., Everly Well, Inc., Exicon Consulting Pvt. Ltd, Faraday Pharmaceuticals, Inc., Foresee Pharmaceuticals Co. Ltd, Fortress Biotech, Inc., HDL Therapeutics, Inc., HeartFlow, Inc., Hummingbird Bioscience, Insmed, Inc., Ionis Pharmaceuticals, Janssen and affiliates, Kowa Research Institute, Inc., Lexicon Pharmaceuticals, Inc., MedImmune Ltd, Merck & affiliates, Nectero Medical, Inc., Novartis Pharmaceuticals Corp., Novo-Nordisk, Inc., Osiris Therapeutics, Inc., Pfizer, Inc., PhaseBio Pharmaceuticals, Inc., Prairie Education and Research Cooperative, Prothena Biosciences Ltd, Regeneron Pharmaceuticals, Inc., Regio Biosciences, Inc., Sanofi–Aventis Group, Silence Therapeutics PLC, Smith & Nephew plc, Stealth BioTherapeutics, Inc., Tourmaline Bio, Inc., VarmX, and Virta Health Corporation. M.M.M. receives research support from Mars and ACI Medical. The other authors declare no competing interests.

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Nature Reviews Disease Primers thanks Mehdi Shishehbor, Nelson Wolosker, Raphael Ritti-Dias and Subhash Banerjee for their contribution to the peer review of this work.

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Aboyans, V., Canonico, M.E., Chastaingt, L. et al. Peripheral artery disease. Nat Rev Dis Primers 11, 68 (2025). https://doi.org/10.1038/s41572-025-00651-0

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