Management of peripheral arterial disease in primary care.

that can affect any artery of the body and can manifest clinically as ischaemic heart disease (coronary arteries), stroke (cerebral arteries) and peripheral arterial disease (PAD). PAD affects the arteries supplying the lower limbs below the level of the renal arteries. Diagnosis of symptomatic PAD is based on a triad of a positive history, absent pulses and reduced ankle brachial pressure indices (ABPI). Intermittent claudication (IC) is characterised by cramping pain in leg muscles precipitated by walking and rapidly relieved by rest only to return on resumption of walking. Differential diagnoses for IC include osteoarthritis, where the pain is relieved once the load is removed from the affected joint, or spinal stenosis, which often requires the patient to sit or even lie down to relieve the pain. Critical limb ischaemia (CLI) is a severe manifestation of PAD and is characterised by rest pain, ulceration, tissue loss and/or gangrene, typically with a systolic pressure of less than 50mmHg.