Pain in the calf muscles after walking two blocks, forcing the person to stop, passing at rest, reproducible at the same distance — the teaching portrait of intermittent claudication. This is the classic manifestation of atherosclerosis of the lower limb arteries.
Peripheral artery disease (PAD) in the context of this course is atherosclerotic stenosis of the limb arteries. The Kazakhstan Ministry of Health protocol No. 196 codes I70.2 and I73.9 within the scope of atherogenic dyslipidaemias. On physical examination: weakened pulse at the a. dorsalis pedis and a. tibialis posterior, a bruit over the femoral artery, trophic skin changes in severe cases.
Complications of the territory.
- Intermittent claudication.
- Rest pain, more often at night, relieved in the sitting position — a sign of severe ischaemia (the Kazakhstan Ministry of Health protocol No. 196 describes exactly this pattern).
- Critical ischaemia / chronic limb-threatening ischaemia: rest pain and/or ulcers, gangrene.
- Acute ischaemia due to thrombosis on a plaque or embolism.
- Amputation as the outcome of unrestored perfusion.
- Concomitant coronary and carotid disease: atherosclerosis rarely lives in one territory. The presence of PAD is a marker of very high cardiovascular risk if documented as ASCVD (ESC/EAS 2025: peripheral arterial disease is part of documented ASCVD).
The ankle-brachial index (ABI) is the ratio of systolic pressure at the ankle to the pressure at the arm. The Kazakhstan Ministry of Health protocol No. 196 includes ABI measurement among the additional methods "as indicated", but there are no numerical diagnostic cut-offs in the open text of the protocol. Therefore the course does not name a "normal / borderline / pathological" ABI as a Kazakhstani threshold: the method objectifies perfusion when the pulse is doubtful and helps find asymptomatic PAD, and the specific cut-off is taken from the document that the given service actually uses.
The boundary of the lesson. Not all leg pain on walking is claudication: spinal canal stenosis causes neurogenic claudication (pain on walking and standing, relief on flexion). Not every gangrene of a toe is atherosclerosis: there is embolism, vasculitis, diabetic microangiopathy without main-vessel stenosis. The diabetic foot is a separate syndrome in which ischaemia, neuropathy and infection are mixed; the course names atherosclerosis as one of the contributors, not as the only cause.
The link to lipids. Documented PAD = ASCVD = very high risk = LDL-C target <1.4 mmol/L and a reduction ≥50% (ESC/EAS 2019/2025). This is where "claudication" stops being a local orthopaedic complaint and becomes an indication for intensive secondary prevention, even if the patient came "only to see the surgeon".