Peripheral artery disease (PAD) is one of the more insidious cardiovascular diseases (CVDs) as it is frequently asymptomatic and many patients are diagnosed only when they already have symptoms of the advanced stage of the disease. Fortunately, there are cost-effective diagnostic tools for preventing screening, but they are often underutilised, particularly for patients at risk.

It is estimated that about 40% of patients with PAD are entirely asymptomatic, about half of them have symptoms that could be attributed to other medical conditions, and only 10% have symptoms typical for the disease [1, 2]. This means that the majority of the more than 202 million (estimate for the year 2010) individuals with PAD are undiagnosed and without proper treatment, which could delay or mitigate the manifestation of more severe symptoms and reduce the risk of cardiovascular issues and death [3, 4].

Despite the high prevalence of asymptomatic patients, there are still more than half of those who could be stratified into groups more or less likely affected by the disease, notably if taking into account the well-recognised risk factors. Some symptoms, while similar or identical to those of other medical conditions, can give clues about the possible presence of PAD – the most likely candidates are smokers, diabetics, individuals with a family history of the disease, and patients with other CVDs.

Common symptoms of PAD

  • Intermittent claudication. The most common and typical symptom (in symptomatic patients) of PAD manifests as cramping, pain in calf muscles (can also be felt in the buttocks, thighs or feet) while walking or exercising. The pain/discomfort usually subsides when the patient takes a rest – hence intermittent [5].
  • Weak or entirely absent pulse in the legs and feet. Abnormal pulse in the posterior tibial artery has a 48.7% predictive value for PAD [6].
  • The colour of the skin on the affected leg changing to a blueish or pale hue. Individuals with moderate to severe PAD often exhibit unusual pallor in the affected leg when it is in an elevated position (during examination) [7].
  • Lower temperature in the affected leg (in comparison with the unaffected limb or the rest of the body).
  • Scaly and shiny skin on the affected leg. Skin texture is noticeably different on the affected leg(s) in comparison with the non-affected limb or the leg of a healthy individual.
  • Poor toenail and hair growth on the affected leg. Diminished flow of nutrients in the blood to the lower extremities leads to stunted growth or malformation of toenails and even complete hair loss.
  • Sores, ulcers and wounds on the feet, usually non-healing in nature. Most typical for PAD are arterial insufficiency ulcers (also known as ischaemic ulcers), which are the second most common type (10 to 30% of all cases of ulceration) of lower-extremity ulcers [8].
  • Gangrene. The most extreme and obvious symptom/complication of PAD that ultimately requires partial or complete amputation of the affected limb to save life [9].
  • Erectile dysfunction in men, especially if they are diabetic. There is a strong correlation between PAD and erectile dysfunction (ED), with one study showing that the likelihood of individuals with ED also having PAD was twofold compared to the control group without ED [10].

Knowledge of the symptomatology of PAD is prerequisite for a successful diagnosis, but any diagnosis based solely on the presence of symptoms should be rebuffed in favour of an ABI score.

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