Most common symptom is intermittent claudication, a muscular aching or cramping with exercise, quickly relieved by rest. Pain in buttocks and thighs suggests aortoiliac disease; calf muscle pain implies femoral or popliteal artery disease. More advanced arteriosclerotic obstruction results in pain at rest; painful ulcers of the feet (sometimes painless in diabetics) may result.

Decreased peripheral pulses (ankle:brachial index usually <0.90; <0.5 indicates severe ischemia), blanching of affected limb with elevation, dependent rubor (redness). Ischemic ulcers or gangrene of toes may be present.

Segmental pressure measurements and Doppler ultrasound of peripheral pulses before and immediately after exercise localizes stenoses; magnetic resonance angiography, computed tomographic angiography (CTA), or conventional arteriography is performed if mechanical revascularization (surgical or percutaneous) is planned.

Most pts can be managed medically with daily exercise program, careful foot care (especially in diabetics), treatment of hypercholesterolemia, and local debridement of ulcerations. Abstinence from cigarettes is mandatory. Antiplatelet and statin therapies are indicated to reduce future cardiovascular events. Some, but not all, pts note symptomatic improvement with drug therapy (cilostazol or pentoxifylline). Pts with severe claudication, rest pain, or gangrene are candidates for revascularization (arterial reconstructive surgery or percutaneous transluminal angioplasty/stent placement).