CVR Physiotherapy › Chapter 6 › 6(a) Arterial disorders

Peripheral arterial disease, Buerger's disease and other arterial disorders

Arterial disease was in 18 of 20 papers (2016–2026), mostly as 3-mark tests (ABI, special tests) and 7-mark questions; ABI alone was asked in S23, S24, W25 and S26. The long answers describe a smoker whose calf pain stops him walking; the answer is ICF plus a dosed walking programme.

Syllabus: Ch 6(a)(viii) Other arterial disorders; arterial ulcers from 6(h)
Priority: Tier 1. In 18 of 20 papers (2016–2026). 3 long-answer cases (none since 2022) and many short questions.
Asked as: LAQ S16W17W22 7m S17W17S19S22W24S25 3m W16S17S18W18S20W20S21S23S24W25S26
Usual split: 5 + 5 + 5, 7 + 8 (functional diagnosis + management), or 5 + 3 + 7 (impairments, complications, management)
Checked against: 2024 ACC/AHA multisociety guideline on lower-extremity PAD; AHA and SVS exercise recommendations; 2023 ESC-led consensus on exercise in PAD; Shionoya and Olin criteria for Buerger's disease. Full list under Sources.
Content checked: 19 October 2026. Next review due October 2027.
My revision: Read once Self-test day 1 Day 7 Day 21

1Definition

Peripheral arterial disease (PAD) is narrowing or blockage of the arteries supplying the limbs, usually the legs, so the muscles and skin get too little blood. The cause is almost always atherosclerosis.

Intermittent claudication is cramping pain in a muscle group, usually the calf, that comes on with walking a fairly fixed distance and goes away within a few minutes of rest. It is the main symptom of PAD.

Buerger's disease (thromboangiitis obliterans) is an inflammatory, non-atherosclerotic disease of the small and medium arteries and veins of the hands and feet. It affects young smokers.

2Classification and grading

Clinical presentation

Asymptomatic PAD: found only on testing.
Chronic symptomatic PAD: intermittent claudication.
Chronic limb-threatening ischaemia (CLTI): rest pain, non-healing ulcer or gangrene.
Acute limb ischaemia: sudden loss of blood supply from an embolus or thrombosis. This is a surgical emergency.

ABI number line and Fontaine stages

Severity climbs upwards. Stages III and IV are chronic limb-threatening ischaemia.

ABI interpretation (3 marks in S17, W18, S23, S24, W25 and S26)
ABI	Meaning
Above 1.40	Non-compressible, calcified arteries (common in diabetes and kidney disease). Result unreliable; measure the toe–brachial index (0.70 or less = PAD).
1.00–1.40	Normal
0.91–0.99	Borderline
0.90 or less	PAD. Textbooks commonly grade severity as 0.70–0.90 mild, 0.40–0.69 moderate, and below 0.40 severe (rest pain and ulcers likely).

Fontaine and Rutherford

Fontaine	Symptoms	Rutherford category
I	Asymptomatic	0
IIa	Mild claudication, walks more than about 200 m	1
IIb	Moderate to severe claudication, less than about 200 m	2–3
III	Ischaemic rest pain	4
IV	Ulceration or gangrene	5–6

Other arterial disorders in the syllabus

Buerger's disease (sections 3–5 below).
Raynaud's phenomenon: fingers turn white, then blue, then red on exposure to cold or stress, because small arteries spasm. Primary (no cause) or secondary (for example to scleroderma).
Acute limb ischaemia: embolus (often from atrial fibrillation) or thrombosis on an existing plaque.
Aneurysm: a balloon-like widening of an artery, most often the abdominal aorta or popliteal artery. It can rupture or throw clots.

3Causes and risk factors

Atherosclerotic PAD

Smoking (cigarettes and bidi): the strongest risk factor.
Diabetes: disease is more distal (below the knee) and often combined with neuropathy.
Age over 50–65, hypertension, abnormal lipids, chronic kidney disease, family history.

Buerger's disease: diagnostic criteria

Shionoya (1998)	Olin (2000)
Smoking history Onset before age 50 Blocks in the arteries below the knee Arm involvement or migrating superficial phlebitis No atherosclerotic risk factors other than smoking	Age under 45 Current or recent tobacco use Distal limb ischaemia (claudication, rest pain, ulcers or gangrene) confirmed by tests Autoimmune disease, clotting disorders and diabetes ruled out No source of emboli; typical angiogram

Exam point

The S16 and W17 case (a 25-year-old male chronic smoker with claudication and cold feet with sweating) is Buerger's disease. Say so in the first line of your answer.

4Pathophysiology to impairments

For "impairments with clinical reasoning" (W22), explain why walking hurts and why exercise helps.

Atherosclerotic plaque narrows the artery. At rest, blood flow through the narrowing is still enough.
Walking raises the calf muscles' oxygen demand, but the narrowed artery cannot raise its supply.
The muscle becomes ischaemic, produces lactic acid and other metabolites, and pain starts: claudication. Resting lowers the demand, so the pain goes.
The patient walks less, so muscles weaken and fitness falls. The distance he can walk shrinks further.
When the narrowing becomes severe, even resting flow is not enough: rest pain, then skin breakdown, ulcers and gangrene.

Where the block is decides where the pain is: aorto-iliac disease gives buttock and thigh pain; femoro-popliteal disease (the commonest site, and the S19 popliteal case) gives calf pain; tibial disease gives foot pain.

Why does walking exercise help if it causes pain?

Repeated walking to moderate pain improves the muscle's ability to use oxygen, opens up collateral vessels around the block, improves the lining of the arteries, and makes walking more efficient. The block itself does not go away, but the patient walks much further before pain starts.

Why is rest pain worse at night and better with the leg hanging down?

Lying flat removes the help of gravity, and the heart pumps a little less during sleep. Hanging the leg down uses gravity to push more blood into the foot.

Recall check. Explain claudication in three sentences: what causes the pain, why rest relieves it, and why exercise helps.

5Clinical features

Symptoms

Calf, thigh or buttock cramping pain on walking, relieved by standing still within a few minutes. The W22 head clerk gets pain after 5 minutes and stops at 10 minutes.
Rest pain in the toes and forefoot at night, relieved by hanging the leg over the bed.
Cold feet, numbness, slow-healing wounds.

Signs

Cool, pale skin; thin, shiny, hairless skin; thick, brittle nails; wasted calf (W22: "legs appear thin, skin dry").
Weak or absent pulses below the block.
Pallor when the leg is raised and dusky red colour (dependent rubor) when it hangs down.
Delayed capillary refill; ulcers on the toes, heel or pressure points; gangrene.

Buerger's disease: extra features

Young male smoker; starts in the feet and often the hands too.
Foot (instep) claudication, cold sensitive fingers and toes, Raynaud's-like colour changes.
Migrating red tender lines along superficial veins (superficial thrombophlebitis).
Painful ulcers and gangrene of the fingertips and toes.

Acute limb ischaemia: the 6 P's (emergency)

Pain, Pallor, Pulselessness, Paraesthesia, Paralysis, Perishing cold. Stop and call the doctor at once.

Don't confuse: vascular and neurogenic claudication
Feature	Vascular (PAD)	Neurogenic (spinal canal stenosis)
Pain comes on	After a fixed walking distance	On walking or standing; distance varies
Relieved by	Standing still for a few minutes	Sitting or bending forward; takes longer
Uphill or cycling	Worse	Uphill or cycling (spine flexed) often easier
Pulses	Weak or absent	Normal

6Investigations and special tests

"Three special tests to assess arterial insufficiency" was asked three times (W16, S18, W20). ABI was asked three more times.

Ankle–brachial index: how to do it

Patient lies flat and rests for 5–10 minutes.
Measure systolic pressure in both arms with a BP cuff and hand-held Doppler. Take the higher one.
Measure systolic pressure at the dorsalis pedis and posterior tibial arteries of each ankle, cuff just above the ankle. Take the higher of the two for each leg.
ABI = ankle systolic pressure ÷ higher arm systolic pressure, for each leg.
Interpret with the table in section 2.

Bedside special tests for arterial insufficiency
Test	How	Positive result
Pulse palpation	Feel femoral, popliteal, dorsalis pedis and posterior tibial pulses on both sides	Weak or absent. Grade 0 absent, 1+ weak, 2+ normal, 3+ full, 4+ bounding.
Buerger's test	Lying, raise the leg slowly; note the angle at which the foot turns pale (Buerger's angle). Then sit the patient up with the legs hanging down.	Pallor at a low angle (below about 20° means severe ischaemia); then slow, dusky red colour on hanging (dependent rubor)
Capillary refill time	Press the nail bed or pulp for a few seconds and release	Colour takes longer than about 2 seconds to return
Venous filling time	Raise the leg for about 1 minute, then hang it down; time how long the foot veins take to refill	Refilling takes longer than about 20 seconds
Treadmill walking test	Walk at a set speed and grade; record when pain starts and when the patient must stop	Pain-free (initial claudication) distance and maximum walking distance; used to measure progress
Allen's test (hand)	Press both radial and ulnar arteries, patient clenches, then release one	Hand stays pale when one artery is released: that artery is blocked (useful in Buerger's)

Other investigations

Doppler ultrasound (duplex): shows the site and degree of the block.
Toe–brachial index when the ABI is over 1.40.
CT or MR angiography and conventional angiography before angioplasty or bypass.
Blood tests: blood sugar and HbA1c, lipids, kidney function.

7Medical and surgical management

Stop smoking completely. For Buerger's disease this is the only treatment proven to halt the disease; even a few cigarettes or bidis a day keep it active.
Antiplatelet drug, statin, BP and diabetes control to cut the high risk of heart attack and stroke.
Cilostazol can reduce claudication symptoms.
Supervised exercise therapy is first-line treatment for claudication (section 12).
Revascularisation when claudication still limits life after exercise therapy, or for limb-threatening ischaemia: angioplasty with or without a stent, or a bypass graft (for example femoro-popliteal bypass).
Wound care, infection control, and amputation if the limb cannot be saved (see the amputation page).
Acute limb ischaemia: urgent anticoagulation and removal of the clot (embolectomy) or bypass.

8Complications and prevention

W22 asks for "complications which he is likely to face giving reason, along with their preventive measures".

Complication	Reason	Prevention
Arterial ulcer	Poor blood supply; minor injury cannot heal	Daily foot inspection, proper footwear, no barefoot walking, nail care
Infection and gangrene	Ischaemic tissue dies; diabetes worsens infection	Early treatment of any wound; blood-sugar control
Amputation	Non-healing gangrene or CLTI	Stop smoking, exercise, foot care, early referral
Heart attack and stroke	The same atherosclerosis affects the heart and brain	Risk-factor control, regular exercise
Deconditioning, weight gain, low mood	Pain makes him avoid walking	Graded walking programme, education
Burns and pressure injury	Numb, ischaemic skin cannot sense heat or pressure	No hot-water bottles or heating pads on the feet; padded heels in bed
Neuropathic ulcer (with diabetes)	Loss of protective sensation	Monofilament check, offloading footwear

9PT assessment

S21 asked to "enumerate evaluation parameters for peripheral arterial disorders". This list is the answer.

History: claudication site, onset distance or time, time to stop, recovery time; rest pain; smoking (pack-years, bidi); diabetes, HTN, heart disease; occupation, walking demands, stairs at home.
Inspection: colour, hair loss, nails, muscle wasting, ulcers and gangrene (site, size, base, edge), oedema.
Palpation: skin temperature (compare sides), pulses with grades.
Special tests: ABI, Buerger's test, capillary refill, venous filling time.
Sensation: 10 g monofilament if diabetic.
ROM and strength: ankle dorsiflexion and calf strength; joint stiffness from inactivity.
Walking capacity: treadmill test or 6-minute walk test with pain-free and maximum distance; claudication pain scale.
Questionnaires: Walking Impairment Questionnaire; quality of life (VascuQoL).

10PT diagnosis by ICF

Draw the six-box ICF model (see the IHD page), then fill it from the case.

Worked example from a real paper (W22, 5 + 3 + 7 marks)

"A fifty year old male head clerk, chain smoker, non-vegetarian, diabetic has come with chief complaint of pain on walking for five minutes and is unable to continue walking after 10 minutes. His legs appear thin & leg skin dry. Discuss the clinical reasoning for the impairments, state the complications which he is likely to face giving reason along with their preventive measures if any. Discuss the management in details."

Spot the ICF clues before you write

pain on walking for five minutes is intermittent claudication with a pain-free walking time of 5 minutes. chain smoker and diabetic are personal factors and risk factors. thin legs, dry skin are trophic changes of chronic ischaemia. head clerk means a sitting job, so walking to work and around the office matters.

ICF component	From this case	Clinical reasoning
Health condition	Peripheral arterial disease with intermittent claudication (Fontaine II), diabetes	Atherosclerosis worsened by smoking and diabetes
Body function and structure impairments	Claudication pain after 5 minutes of walking Reduced walking endurance (stops at 10 minutes) Calf muscle wasting and weakness Trophic skin changes: dry, thin skin Possible reduced sensation (diabetes) Reduced cardiorespiratory fitness	Narrowed artery cannot meet exercise demand, so ischaemic pain Pain-avoidance and chronic ischaemia waste the muscle Poor blood supply starves the skin
Activity limitations	Walking more than about 10 minutes, climbing stairs, shopping, walking to the bus or office	Pain forces him to stop
Participation restrictions	Commuting to work, social outings, family errands, leisure walks	Limited walking distance restricts life outside home
Environmental factors	Barriers: easy access to cigarettes; non-vegetarian, possibly fatty diet at home. Facilitators: desk job, family support, access to a hospital programme.	Barriers become education goals
Personal factors	50-year-old man, chain smoker, diabetic	Readiness to quit smoking decides prognosis

One-line functional diagnosis

A 50-year-old diabetic head clerk and chain smoker with peripheral arterial disease, who has calf claudication after 5 minutes of walking, reduced walking endurance, calf wasting and trophic skin changes. These limit walking, stairs and outings, and restrict commuting and social life. Smoking and diet are barriers; a desk job and family support are facilitators.

Recall check. Fill the ICF boxes for the 25-year-old smoker with claudication and cold sweaty feet (S16, W17).

11Problem list and goals

Goals for the W22 head clerk
Problem	Short-term (4 weeks)	Long-term (12 weeks and beyond)
Claudication	Understands the walking programme and claudication pain scale; walks within it 3 times a week	Pain-free walking time and maximum walking time clearly increased
Muscle weakness	Better calf endurance (heel raises)	Normal calf strength for his age
Skin and feet	Inspects his feet daily; no new wounds	No ulcers; good foot-care habits
Risk factors	Sets a quit date; referred for cessation support	Tobacco-free; HbA1c, BP and lipids controlled
Participation	Walks to the bus stop with planned rest stops	Commutes and does errands without stopping; walks for leisure

12PT management

1. Supervised exercise therapy (the core treatment)

Memory hook: the walking prescription

30 / 3 / 12

30–45 minutes of walking per session (build up to it)
3 sessions or more a week
12 weeks at least

Checked against the AHA exercise recommendations and the 2023 ESC-led consensus. The 2024 ACC/AHA guideline gives supervised exercise Class 1, Level A.

Interval walking programme
Part	Dose
Warm-up	5–10 min slow walking and calf stretches
Walking bouts	Treadmill or level ground. Walk until claudication pain reaches moderate to strong (about 2–3 on the 4-point claudication scale), then stop.
Rest	Stand or sit until the pain has fully gone, then walk again
Total	Repeat walk–rest cycles to reach 30–45 min of exercise time, ≥3 times a week, for ≥12 weeks
Progression	When he can walk about 8–10 minutes before moderate pain, raise the treadmill speed or slope
Cool-down	5–10 min slow walking and stretches

Claudication pain scale: 1 = pain starts, mild; 2 = moderate; 3 = intense; 4 = unbearable. Write "walk to moderate pain (grade 2–3), rest until it goes, repeat" in the exam.

If walking is not possible (foot ulcer, arthritis): arm cranking or cycling also improve walking ability (2024 guideline, Class 2a).
If supervision is not available: a structured home walking programme with a log book, at least 30 minutes, 3–5 times a week.
Add: calf and thigh strengthening (heel raises, sit-to-stand), and stretching of the calf muscles.

2. Buerger's disease (7 marks in S17 and S22)

Absolute stop of all tobacco, including bidi, chewing tobacco and passive smoke.
Walking programme as above, within tolerance; foot (instep) muscle and calf exercises.
Buerger–Allen exercises (classic, below) and position changes to aid circulation.
Keep hands and feet warm with socks and gloves; avoid cold exposure, but never apply direct heat.
Meticulous foot and hand care; protect ulcers; manage pain with positioning (leg slightly down at night).
After amputation of digits or limb: stump care and prosthetic training.

Classic answer vs current evidence: Buerger–Allen exercises

Classic

Lying, raise the leg to about 45–90° until the skin blanches (about 1–2 minutes).
Sit with the leg hanging down until it turns red (about 2–5 minutes), with ankle movements.
Lie flat with the leg level for about 5 minutes.
Repeat the cycle several times, a few times a day.

Current

There is little good evidence for Buerger–Allen exercises. Supervised walking to moderate claudication pain has the strongest evidence (Class 1, Level A) and should be the main treatment whenever the patient can walk.

Write in the exam

"Supervised interval walking 30–45 min, ≥3 times a week, ≥12 weeks, is the main treatment; Buerger–Allen exercises may be added."

3. Rest pain, ulcers and limb-threatening ischaemia

Sleep with the head of the bed slightly raised or the leg slightly lower; do not elevate an ischaemic leg.
Protect heels with padding; turn regularly.
Gentle active ankle and toe exercises within comfort; no walking on an open ulcer without offloading footwear.
After angioplasty or bypass: early walking as the surgeon allows; protect groin wounds; then a walking programme.

By impairment (for "management in detail")

Impairment	Technique and dose	Why
Claudication, low walking tolerance	Interval walking to moderate pain (grade 2–3), rest, repeat; 30–45 min, ≥3 times a week, ≥12 weeks	Improves muscle oxygen use, collaterals and walking economy
Calf weakness and wasting	Heel raises, resisted plantarflexion, sit-to-stand: 2–3 sets of 10–15, 2–3 times a week	Stronger muscles do the same work with less blood
Reduced ankle range	Active ankle and toe ROM, calf stretches 30 s × 3	Keeps a normal gait pattern
Poor skin, ulcer risk	Daily foot inspection, moisturiser (not between toes), proper footwear	Prevents the small wounds that turn into ulcers
Smoking, diabetes	Brief advice at every session; referral to cessation services; exercise for sugar control	Removes the cause of progression

Recall check. Write the "30 / 3 / 12" walking prescription and the claudication pain scale from memory.

13Precautions, contraindications and stop criteria

Take care

No heat (hot packs, shortwave, hot water) on an ischaemic limb: blood flow cannot carry the heat away and the skin burns.
No compression bandaging if the ABI is low; check ABI before any compression.
Do not elevate the leg in rest pain.
Most patients have heart disease too: check HR and BP, and watch for chest pain during walking.
Diabetics: check blood sugar and feet before and after exercise.
Do not walk on an open foot ulcer without offloading.

Stop and refer urgently if

Any of the 6 P's appear suddenly (acute limb ischaemia)
Chest pain, breathlessness or palpitations during exercise
New rest pain, a new ulcer, or the foot turns black

14Education, lifestyle and home programme

Foot care

Look at your feet every day, including the soles and between the toes. Use a mirror or ask a family member.
Wash in lukewarm water, test the temperature with your elbow, dry well between the toes.
Cut nails straight across. Do not cut corns yourself.
Always wear soft, well-fitting footwear and socks. Never walk barefoot, even at home or in temples.
No hot-water bottles, heating pads or fire near the feet.
Report any colour change, wound or pain at rest at once.

Lifestyle

Stop all tobacco: this is the most important single step.
Keep walking every day using the walk–rest method.
Heart-healthy diet: less fried and fatty food, less salt; control weight.
Take medicines regularly: antiplatelet, statin, BP and diabetes drugs.
Avoid cold; keep hands and feet warm with socks and gloves.

15Prognosis and discharge criteria

Prognosis: most people with claudication do not lose their leg, but they have a high risk of heart attack and stroke. Walking distance improves greatly with supervised exercise. Continued smoking is the strongest predictor of worsening disease and, in Buerger's disease, of amputation.

Discharge from the supervised programme: walks independently with the walk–rest method; can measure progress with a walking log; does daily foot care; has stopped or is actively stopping smoking; knows the warning signs.

16Exam corner

Past questions (MUHS, 2016–2026)

S16 Q4(b), 5 + 5 + 5 marks; W17 Q4(b), 7 + 8 marks25-year-old male chronic smoker with intermittent claudication and cold feet with sweating. Functional diagnosis and physiotherapy management.
W22 Q3(a), 5 + 3 + 7 marksThe worked example in section 10.
7-mark questionsPhysiotherapy in Buerger's disease (S17, S22). Physiotherapy for claudication in arterial disease of the popliteal artery (S19). ABI and its significance (W17). Physiotherapy for peripheral arterial disorders (W24). Assessment and physiotherapy of PAD (S25).
3-mark questionsABI (S17, W18). Three special tests for arterial insufficiency (W16, S18, W20). Intermittent claudication (S20). Evaluation parameters for peripheral arterial disorders (S21). Normal and abnormal grades of ABI (S23). Grades of ABI (S24). ABI (W25). Interpretation of ABI (S26).

Technique cards for this topic: exercise testing, scales, exercise physiology, therapeutic exercise for circulation, bedside vascular tests.

Keywords to underline

intermittent claudication ABI ≤ 0.90 Buerger's test Fontaine supervised exercise therapy walk to moderate pain, rest, repeat 30–45 min, 3 times a week, 12 weeks collateral circulation stop smoking foot care no heat

Answer skeleton: claudication long answer

Name the condition from the case (PAD, or Buerger's disease in a young smoker) and its stage (Fontaine).
[ICF or impairments, 5–7] ICF diagram from the case; reasoning for claudication, wasting and skin changes.
[Complications, 3] if asked: ulcer, gangrene, amputation, heart attack and stroke, with prevention.
[Management, 7–8] Assessment tests (ABI, Buerger's); supervised walking with dose; strengthening; foot care; smoking cessation; precautions (no heat); progression and outcome measures.

Draw these

The ABI number line and Fontaine ladder (section 2)
A table of arterial vs venous ulcers (see the venous page)

Viva questions

How do you calculate the ABI, and what does 0.6 mean?
Why can the ABI be falsely high in a diabetic?
What is Buerger's angle?
How is vascular claudication different from neurogenic claudication?
Why must you not apply heat to an ischaemic leg?
What are the 6 P's?

Test yourself

Answer on paper first, then open the answer.

3 mThree special tests to assess arterial insufficiency.

ABI: ankle systolic ÷ higher arm systolic; ≤ 0.90 indicates PAD.
Buerger's test: pallor on raising the leg at a low angle, then dependent rubor on hanging it down.
Capillary refill time: longer than about 2 seconds. (Also accept pulse palpation or venous filling time over 20 seconds.)

3 mAnkle–brachial index.

Ratio of ankle to arm systolic pressure, measured with a Doppler after 5–10 minutes' rest. Normal 1.00–1.40; borderline 0.91–0.99; PAD ≤ 0.90 (severe below 0.40); over 1.40 means calcified arteries, so use the toe–brachial index.

7 mPhysiotherapy management in Buerger's disease.

Define (inflammatory disease of small and medium vessels, young smokers). Aims. Then: absolute tobacco cessation; supervised interval walking with dose; Buerger–Allen exercises (classic); warmth without direct heat; foot and hand care; positioning for rest pain; ulcer protection; post-amputation care; education.

MCQA 55-year-old man's ABI is 1.6. What is the best next step?A. Reassure: normal arteriesB. Measure the toe–brachial indexC. Start compression bandagingD. Diagnose severe PAD

B. An ABI above 1.40 means the ankle arteries are stiff and cannot be compressed, so the result is unreliable. The toe–brachial index (0.70 or less = PAD) is used instead.

MCQDuring supervised walking for claudication, the patient should:A. Stop at the first hint of painB. Walk until moderate-to-strong pain, rest until it goes, then repeatC. Walk through unbearable painD. Avoid walking and use only Buerger–Allen exercises

B. Training to moderate claudication pain gives the best gains. Unbearable pain is unnecessary, and stopping at the first hint gives too little stimulus.

MCQWhich is a contraindication in a patient with severe PAD?A. Calf strengtheningB. A hot pack on the calfC. Daily foot inspectionD. Arm ergometry

B. Ischaemic tissue cannot get rid of heat, so it burns easily.

Last recall check. Write the ABI method and bands, three special tests, and the walking prescription.

Sources

Notes written in original words. Diagrams drawn for this site. Numbers were checked against the sources below.

MUHS BPTh syllabus (2012), Cardio-Vascular & Respiratory Physiotherapy. muhs.ac.in
MUHS IV BPTh question papers, code 51413, Summer 2016 to Summer 2026: muhsonline.com (unofficial archive, 2016–2022) and the Dhole Patil College of Physiotherapy past-paper page (2019–2026)
Gornik HL, et al. 2024 ACC/AHA/AACVPR/APMA/ABC/SCAI/SVM/SVN/SVS/SIR/VESS Guideline for the Management of Lower Extremity Peripheral Artery Disease. J Am Coll Cardiol 2024. Key points: acc.org; ABI thresholds as summarised in American Family Physician 2025.
Treat-Jacobson D, et al. Optimal Exercise Programs for Patients With Peripheral Artery Disease: AHA Scientific Statement. Circulation 2019.
Society for Vascular Surgery practice guidelines for asymptomatic PAD and intermittent claudication (2015).
ESC-led consensus document on exercise in PAD, Eur Heart J 2023.
Shionoya S. Diagnostic criteria of Buerger's disease. Int J Cardiol 1998. Olin JW. Thromboangiitis obliterans (Buerger's disease). N Engl J Med 2000.
Structure and classical content: Hillegass, Essentials of Cardiopulmonary Physical Therapy, 5th ed. (2022); Cash's Textbook of Chest, Heart and Vascular Disorders for Physiotherapists.

Educational notes for exam preparation. Not medical advice. Hospital protocols and the treating doctor's instructions come first.

Version 1. Content checked 19 October 2026. Next review October 2027.