Understanding Peripheral arterial disease (PAD)

PAD occurs when atherosclerotic plaques narrow or occlude the arteries supplying the lower limbs, resulting in reduced perfusion. Patients may present with intermittent claudication, rest, pain, or, in more advanced stages, non-healing wounds and tissue loss known as chronic limb-threatening ischaemia. 

Many patients, particularly those with diabetes, may present atypically or remain asymptomatic, making vigilance essential.

PAD is strongly associated with an increased risk of myocardial infarction and stroke, as well as progressive loss of mobility and independence. Delayed recognition can result in avoidable amputation, highlighting the crucial role nursing staff play in early identification and escalation.

Assessment and management

Nursing staff play a pivotal role in both the assessment and management of peripheral arterial disease, often acting as the first point of contact within health care services and maintaining continuity of care throughout the patient journey.

In assessment, nursing staff are essential in recognising early signs and risk factors that may otherwise go unnoticed. Through holistic assessment, they are uniquely positioned to identify individuals at risk by eliciting a detailed history, recognising subtle symptom patterns, and undertaking thorough clinical examination.

The ability to perform and interpret investigations such as the ankle-brachial pressure index (ABPI) enables nurses to make timely and informed decisions about escalation and referral. This early identification is crucial, as delayed diagnosis can lead to disease progression and avoidable complications, including limb loss.

Beyond initial assessment, nursing staff play a key role in clinical decision-making and coordination of care. They facilitate access to further investigations, advocate for patients within multidisciplinary teams and ensure that any deterioration is recognised and acted upon promptly. Their clinical judgement is particularly important in complex patients, such as those with diabetes, where standard diagnostic tools may be less reliable.

In management, nursing staff are central to delivering holistic, patient-centred care. They support optimisation of best medical therapy by promoting medication adherence, monitoring response to treatment and addressing modifiable cardiovascular risk factors. Smoking cessation is a particular area where nursing intervention can significantly influence outcomes through education, behavioural support and referral to specialist services.

Nursing staff also play a crucial role in empowering patients to self-manage their condition. By encouraging engagement with exercise programmes and promoting lifestyle changes, they help patients improve functional ability and quality of life. Education is a key component of this, enabling patients to recognise symptoms of deterioration and seek help at the appropriate time.

In patients with wounds or tissue loss, nursing input is vital in delivering timely wound care, preventing infection, and ensuring appropriate escalation. Critically, nurses ensure that vascular status is assessed before initiating interventions such as compression therapy, thereby preventing harm. Their role within multidisciplinary teams ensures coordinated, safe, and effective care.

Finally, nursing staff contribute significantly to service development and quality improvement, using their clinical insight to identify gaps in care, influence practice and advocate for improved pathways. Their involvement at local and national levels is essential in driving improvements in PAD care and reducing unwarranted variations in practice.

The nursing workforce is integral to every stage of PAD care, from early recognition through to long-term management, and its contribution is vital in improving patient outcomes and reducing the burden of this often-overlooked condition.

In my own practice, being recognised as RCN Wales Nurse of the Year 2025 has provided a valuable platform to advocate for patients with PAD. This has enabled me to contribute more actively at a national level, helping to raise awareness of peripheral arterial disease, promote earlier assessment, and influence improvements in care pathways for patients at risk of limb-threatening ischaemia. It reinforces the important role nursing staff play not only in clinical care, but also in shaping wider service development and health care priorities.

Legs Matter

The Legs Matter campaign promotes early assessment and improved care for lower limb conditions, ensuring patients receive the right care at the right time. Legs Matter Week provides an opportunity for health care professionals to raise awareness, share best practice and improve care standards for patients with lower limb conditions.

PAD remains under-recognised despite its impact. Nursing plays a key role in improving outcomes through early identification, holistic care and advocacy at both clinical and national levels. Ultimately, when it comes to patient outcomes, legs really do matter.