Patients with PAD have variable clinical presentations. Approximately 50% of patients with PAD are asymptomatic, 30% have atypical symptoms and only a small proportion (15%) of patients have typical claudication. CLI may be an initial presenting symptom in 2-3% of patients (Figure 3). Patients with typical claudication have lower extremity pain, discomfort, heaviness, fatigue, tightness, cramping, or burning localized to the calf, thigh, hip, or buttock that appears with walking and resolves with rest. It often recurs at the same distance once walking is resumed. With atypical claudication, lower extremity discomfort may occur with walking but may not consistently occur at the same distance walked and may require a longer duration to resolve or require the patient to sit down or change body position to alleviate the symptoms. Patients with CLI have pain at rest, which worsens with limb elevation and improves in a dependent position. As the extent of ischemia worsens, patients may develop ulcerations, gangrene, paresthesias, or paralysis.
