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Practice Clinical updates

Peripheral artery disease

BMJ 2018; 360 doi: (Published 01 February 2018) Cite this as: BMJ 2018;360:j5842
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Signs and symptoms of peripheral artery disease

  1. Rachael L Morley, academic foundation doctor1 2,
  2. Anita Sharma, general practitioner, clinical director in vascular care Oldham CCG, GP member of NICE Quality Standards Advisory Committee3,
  3. Alexander D Horsch, consultant interventional and diagnostic radiologist1,
  4. Robert J Hinchliffe, professor of vascular surgery1 2
  1. 1North Bristol NHS Trust, Bristol, Bristol, UK
  2. 2Bristol Centre for Surgical Research, NIHR Bristol BRC, University of Bristol, UK
  3. 3South Chadderton Health Centre, Oldham, UK
  1. Correspondence to: R J Hinchliffe robert.hinchliffe{at}

What you need to know

  • Most people with peripheral artery disease are asymptomatic

  • Peripheral artery disease is associated with a high risk of vascular complications such as myocardial infarction, stroke, vascular dementia, renovascular disease, and mesenteric disease

  • Few patients with intermittent claudication develop limb-threatening complications (1-3% in 5 years)

  • Management of risk factors—including smoking, diabetes, and dyslipidaemia—is key to reducing the risk of vascular complications

  • Patients with critical limb ischaemia are at high risk of limb amputation and premature death

Peripheral artery disease affects around 13% of the Western population who are more than 50 years old.1 It is most commonly due to atherosclerosis, where an atherosclerotic plaque causes arterial stenosis or occlusion. This results in a reduction in blood flow to the affected limb. Most patients are asymptomatic, but many experience intermittent claudication (pain on walking). Critical limb ischaemia occurs when the reduction in blood flow is so severe that it causes pain on rest or tissue loss (ulceration or gangrene).1

Atherosclerosis is a systemic disease. Some 60% of patients with peripheral artery disease will have ischaemic heart disease, and 30% have cerebrovascular disease.2 Within five years of diagnosis, 10-15% of patients with intermittent claudication will die from cardiovascular disease.3 Therefore, management begins with identification and modification of risk factors that are common to peripheral artery disease, heart disease, and stroke.

Sources and selection criteria

We used Healthcare Databases Advanced Search (HDAS) to search Embase, Medline, and PubMed for the most up to date systematic reviews and meta-analyses or alternative highest level of evidence on peripheral artery disease or intermittent claudication. Searches were performed during September 2017 with no date limits applied.

We also consulted national and international guidelines, particularly those published by the National Institute for Health and Care Excellence (NICE) and the Trans-Atlantic Inter-Society Consensus for the Management of Peripheral Artery Disease …

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