Peripheral Artery Disease

Peripheral artery disease (PAD) is usually caused by atherosclerotic plaque in the aortoiliac, femoropopliteal, or infrapopliteal arteries; superimposed thrombosis can further reduce or abruptly stop flow. The result is a supply-demand mismatch. At rest, narrowed arteries may still deliver enough oxygen, but exercise increases muscle demand beyond what the narrowed vessel can provide. The predictable result is exertional cramping or aching, called intermittent claudication, that improves when the patient stops walking. As obstruction worsens, resting blood flow may no longer meet tissue needs. The clinical picture then changes from activity-related discomfort to ischemic rest pain, a nonhealing wound, ulceration, or gangrene. PAD is also a marker of systemic atherosclerosis, so the absence of leg symptoms does not make the condition benign; asymptomatic patients still face increased risk for myocardial infarction, stroke, and limb events. An experienced nurse first separates stable exertional symptoms from a sudden change in perfusion. That distinction determines whether the next step is structured outpatient treatment, prompt limb evaluation, or an emergency response.