What is a typical examination finding in a patient with peripheral arterial disease (PAD)?

In patients with peripheral arterial disease (PAD), rest pain in the leg is a typical examination finding due to inadequate blood flow to the lower extremities, particularly during times of rest. This phenomenon occurs mostly at night when the patient is lying down, and it may necessitate the patient to dangle the legs over the side of the bed or walk around to alleviate the discomfort.

Rest pain signifies a more advanced stage of PAD and indicates significant arterial obstruction, as the blood supply is critically insufficient to meet the metabolic demands of the tissues at rest. It is a clear symptom reflecting the underlying pathophysiology of PAD, which involves the narrowing or blockage of peripheral arteries, causing insufficient oxygen delivery to the tissues.

In contrast, normal pedal pulses would indicate adequate blood flow, substantial swelling is more associated with venous issues or other conditions, and calf muscle hypertrophy would suggest an increase in muscle mass rather than the muscle wasting and atrophy that often results from chronic ischemia in severe cases of PAD. Thus, the presence of rest pain is a defining characteristic of significant vascular compromise in patients with PAD.