Management of Peripheral Arterial Disease

Peripheral arterial disease (PAD) is a manifestation of systemic atherosclerosis characterised by narrowing or occlusion of the arteries supplying the lower limbs. Patients commonly present with intermittent claudication and, in advanced cases, with critical limb ischaemia, featuring rest pain or tissue loss. Effective management requires early detection through clinical assessment and measurement of the ankle–brachial index, followed by a combination of lifestyle modification, pharmacotherapy and revascularisation when indicated. Risk‐factor control—smoking cessation, glycaemic and lipid management, and antihypertensive treatment—forms the cornerstone of medical therapy and can halt progression and reduce cardiovascular events. Structured exercise programmes improve walking distance and quality of life, while antiplatelet agents and statins reduce major adverse cardiovascular outcomes. In patients with lifestyle‐limiting claudication or tissue loss, revascularisation strategies range from endovascular techniques, such as balloon angioplasty, stenting, drug‐coated balloons and atherectomy, to surgical bypass using autologous vein conduits. Choice of intervention is guided by lesion characteristics, patient comorbidities and local expertise, with a multidisciplinary vascular team essential to optimise limb salvage and long‐term patency.

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Management of Peripheral Arterial Disease publication trend

The graph below shows the total number of articles in management of peripheral arterial disease across all publications each year (not limited to Nature Index journals).

Technical terms

Ankle–brachial index: Ratio of ankle to brachial systolic pressure, used to detect arterial narrowing.

Intermittent claudication: Exertional calf pain relieved by rest, indicating moderate PAD.

Critical limb ischaemia: Severe PAD with rest pain, ulcers or gangrene, carrying high risk of amputation.

Endovascular therapy: Minimally invasive interventions (angioplasty, stenting, atherectomy) to restore arterial flow.

Bypass surgery: Creation of an alternative conduit, often using autologous vein, to circumvent occluded arteries.

References

1. A vein bypass first versus a best endovascular treatment first revascularisation strategy for patients with chronic limb threatening ischaemia who required an infra-popliteal, with or without an additional more proximal infra-inguinal revascularisation procedure to restore limb perfusion (BASIL-2): an open-label, randomised, multicentre, phase 3 trial. The Lancet (2023).
2. Global burden of peripheral artery disease and its risk factors, 1990–2019: a systematic analysis for the Global Burden of Disease Study 2019. The Lancet Global Health (2023).
3. Editor's Choice -- European Society for Vascular Surgery (ESVS) 2024 Clinical Practice Guidelines on the Management of Asymptomatic Lower Limb Peripheral Arterial Disease and Intermittent Claudication ☆. European Journal of Vascular and Endovascular Surgery (2023).