Peripheral arterial occlusion (acute and chronic). Buerger’s disease (thromboangiitis obliterans)

1. Big picture

Peripheral arterial disease is a manifestation of systemic vascular disease. In the leg, it appears in two major ways:

Clinical form	Core idea	Main danger
Acute peripheral arterial occlusion / acute limb ischemia	Sudden fall in limb perfusion	Limb loss within hours
Chronic peripheral arterial occlusive disease / PAD	Progressive arterial narrowing, usually atherosclerotic	Claudication, chronic limb-threatening ischemia, MI/stroke risk
Buerger’s disease	Non-atherosclerotic inflammatory thrombosis in young smokers	Digital ischemia, ulcers, gangrene

The examiner usually wants you to recognize the pattern:

Sudden cold pale painful pulseless leg = acute arterial occlusion → heparin + urgent vascular intervention
Exertional calf pain relieved by rest = chronic PAD → ABI + risk reduction + exercise ± revascularization
Young heavy smoker with distal ischemia + superficial thrombophlebitis = Buerger’s disease → absolute tobacco cessation

The 2024 ACC/AHA PAD guideline classifies lower-extremity PAD into asymptomatic PAD, chronic symptomatic PAD, chronic limb-threatening ischemia, and acute limb ischemia. ([American College of Cardiology][1])

1. Big picture

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