Peripheral Arterial Disease Management - A Practical Guide for Internists

Sep 14, 2026

Peripheral arterial disease (PAD) is a growing concern affecting over 27 million people across Europe and North America, with consequences extending beyond intermittent claudication and reduced activity. PAD increases the likelihood of major cardiovascular events, premature death, and polyvascular disease in patients with diabetes or other cardiovascular conditions. The guide explains what causes PAD, who is at risk, how to recognize typical and atypical symptoms, and when to assess patients using history, pulse palpation, and objective ABI testing.

LanguageEnglish

CategoryHealthcare

FormatPDF

Pages22

Reading Time55 min

AccessFree to download

About this guide

What is PAD?

Recognising PAD

Who is likely to have PAD?

The consequences of PAD

How to diagnose PAD

When to assess

How to assess

Three steps to assessing PAD

Step 1: Patient history

Step 2: Clinical examination (pulse palpation)

Step 3: Objective testing (ABI)

ABI testing

Peripheral Arterial Disease Management A Practical Guide for Internists EFIM Vascular Working Group 1 ● Peripheral arterial disease (PAD) is a growing concern among our aging population. More than 27 million people are affected by PAD across Europe and North America. ● The effects of PAD are not limited to intermittent claudication and restricted physical activity. Individuals suffer serious cardiovascular events and are at as high a risk of premature death as patients with a history of myocardial infarction or stroke. About this guide ● ● ● Many patients with other cardiovascular conditions, including myocardial infarction and stroke, and those with diabetes, also have PAD. Polyvascular disease (disease in more than one vascular bed) doubles a patient’s chances of further ischaemic vascular events or death. Individuals with PAD are often asymptomatic, sometimes because of limited physical activity. Ankle–brachial index (ABI) testing is a key tool to identify these patients. Internists, whether in hospital-or office-based practices, are ideally placed to identify patients suffering from, or at risk of, PAD because of their role in the continuing care of elderly patients and patients with diabetes, hypertension, dyslipidaemia and chronic renal disease. Internists are ideally placed to identify patients suffering from, or at risk of, PAD 2 ● This Practical Guide has been written specifically for Internists by the EFIM Vascular Working Group to provide clear and relevant advice on best practice in the diagnosis and management of PAD, based mainly on the recently published Trans-Atlantic Inter-Society Consensus for the Management of PAD (TASC II) guidelines. ● The Guide is intended to support Internists in their day-to-day practice, to increase awareness of the value of ABI testing and strengthen the clinical care of this insidious disease. EFIM Vascular Working Group Coen Stehouwer (the Netherlands) Jan Willem Elte (the Netherlands) Denis Clement (Belgium) Marc Lambert (France) Chris Davidson (UK) Daniel Sereni (France) Curt Diehm (Germany) Please click here to view disclosure of interest statements About this guide 3 What is PAD? ● PAD arises from a build-up of atherothrombotic plaques in peripheral blood vessels causing narrowing or partial blockage of the vessels, reduction of blood flow, and consequent ischaemia and tissue damage. Recognising PAD Who is likely to have PAD? ● Symptoms include pain or cramps in the calf muscles or elsewhere in the leg either when at rest, or when walking that disappear at rest (intermittent claudication) . ● Many individuals are asymptomatic. ● The main risk factors for PAD are shown in the table below. Risk factors for PAD (those in red have the strongest association) Male gender Age >65 years Smoking Diabetes (past and present) Hypertension Dyslipidaemia Pre-existing cardiovascular Chronic renal disease, including myocardial insufficiency infarction and stroke Most individuals with PAD do not have the classic symptoms of pain when walking. Many individuals areasymptomatic 4 The consequences of PAD ● 40–60% of patients with PAD will also have coronary artery or cerebrovascular disease. ● The co-presence of PAD with coronary artery and/or cerebrovascular disease (polyvascular disease) almost doubles the possibility of having a major cardiovascular event (myocardial infarction, stroke or vascular-related death) within 1 year. ● Patients with PAD often have other mobility problems and can develop critical limb ischaemia without preceding claudication, which may result in amputation of the foot or leg. Patients with diabetes are especially at risk. ● Approximately 75% of patients with PAD will die of cardiovascular causes. Whether symptoms are present can depend on a patient’s level of activity Be PAD proactive. Most patients have a low awareness of PAD and its consequences, and may not tell you about their

FAQs

What causes peripheral arterial disease (PAD)?

PAD results from a build-up of atherothrombotic plaques in peripheral blood vessels, causing narrowing or partial blockage, reduced blood flow, and consequent ischaemia and tissue damage.

Which patients are more likely to have PAD?

Key risk factors include male gender, age over 65, smoking (past and present), diabetes, hypertension, dyslipidaemia, and pre-existing cardiovascular disease and chronic renal disease. Some individuals are asymptomatic.

How should clinicians diagnose PAD?

Diagnosis involves three steps: patient history, clinical examination with pulse palpation, and objective testing with the ankle–brachial index (ABI). ABI measurements at rest (≤0.9) indicate clinically significant PAD.

Sep 14, 2026

Upload by 8796093062539