Which combination of signs suggests peripheral arterial disease warranting referral?

Which combination of signs suggests peripheral arterial disease warranting referral?

• A. Resting leg pain that improves with activity.
• B. Pain that is worse with activity but improves with rest.
• C. Intermittent claudication, rest leg pain, non-healing wounds, diminished distal pulses.
• D. Numbness in the toes only at night.

Answer: (C)

Peripheral arterial disease signals arise when there is evidence of arterial insufficiency affecting the leg, especially when multiple clues appear together. Pain with walking (intermittent claudication) shows the muscle is starved for blood during activity and improves with rest, which is typical of PAD. If pain occurs at rest, particularly at night, that indicates more severe ischemia. Non-healing wounds point to poor blood supply preventing healing, and diminished distal pulses provide an objective sign that blood flow to the lower leg is reduced. When these signs cluster—exertional leg pain, rest pain, non-healing wounds, and weak or absent pulses—it strongly suggests significant PAD and warrants referral for vascular evaluation and possible revascularization. Isolated symptoms without this combination are less specific and do not by themselves mandate urgent referral.

Peripheral arterial disease signals arise when there is evidence of arterial insufficiency affecting the leg, especially when multiple clues appear together. Pain with walking (intermittent claudication) shows the muscle is starved for blood during activity and improves with rest, which is typical of PAD. If pain occurs at rest, particularly at night, that indicates more severe ischemia. Non-healing wounds point to poor blood supply preventing healing, and diminished distal pulses provide an objective sign that blood flow to the lower leg is reduced. When these signs cluster—exertional leg pain, rest pain, non-healing wounds, and weak or absent pulses—it strongly suggests significant PAD and warrants referral for vascular evaluation and possible revascularization. Isolated symptoms without this combination are less specific and do not by themselves mandate urgent referral.