Peripheral Artery Disease

Narrowed leg arteries restricting blood flow to the muscles — felt as cramping calf, thigh, or buttock pain on walking that eases with rest (claudication). PAD is far more than a leg problem: it signals systemic atherosclerosis, and its presence substantially raises heart attack and stroke risk.

Evidence synthesis: Supervised exercise therapy has strong randomised-trial evidence — it improves walking distance as much as or more than angioplasty for claudication, and guidelines list it as first-line. Statins, antiplatelets, and smoking cessation are proven to reduce cardiovascular events in PAD patients; smoking is both the dominant cause and the biggest modifiable driver of progression. Ginkgo biloba has a Cochrane review showing marginal, clinically insignificant walking-distance gains. Omega-3s have no PAD-outcome trials, though their triglyceride and endothelial effects provide a plausible adjunct rationale. Cold, mottled, non-healing feet or rest pain signal critical limb ischaemia — a vascular emergency.