8
Diagnosis
Table 4. Clinical Subsets of Patients With PAD
Clinical
Subset Description/Characterization
Asymptomatic
PAD
(may have
functional
impairment)
• Depending on the population assessed and method of assessment,
20%–59% of patients with objectively proven PAD report no leg
symptoms.
• Patients classified as having asymptomatic PAD may self-limit and
adapt their activity to remain below their ischemic threshold to avoid
leg pain.
• A significant percentage of patients with asymptomatic PAD who
report no exertional leg symptoms develop symptoms during an
objective walking test.
• The prevalence of asymptomatic PAD varies depending on whether
patients are recruited from a primary care or community setting
(lower %) versus a vascular laboratory (higher %).
• Patients with PAD who are asymptomatic have functional
impairment comparable to patients with claudication.
• Associated with increased risk of MACE including mortality.
Chronic
symptomatic
PAD
(includes
claudication
and other
ischemia-
related
exertional leg
symptoms)
• Most common clinically evident subset of PAD; patients report
claudication or other nonjoint-related exertional leg symptoms that
can limit walking performance.
• Exertional leg symptoms (typical claudication or other) reported in
up to 80% of patients with objectively proven PAD, depending on
case series.
• Includes ischemia-related exertional leg symptoms, not present at
rest, generally increasing with progressive exercise intensity and
quickly relieved by rest (within 10 min).
• Typical claudication symptoms may be described as a pain, aching,
cramping, or tired/fatigued feeling located in the buttocks, thigh,
calf, or foot that occurs consistently during walking, does not start at
rest, does not improve during walking, and is usually relieved within
approximately 10 min of rest. Leg symptom descriptors also include
tingling, numbness, burning, throbbing, or shooting.
• For some patients, exertional leg symptoms due to PAD are not
typical of claudication because they may not limit walking or may
take >10 min to resolve after rest.
• Chronic symptomatic PAD is associated with significant functional
(walking ) impairment, regardless of whether symptoms are typical of
claudication.
