Peripheral artery disease in patients with persistent claudication after lumbar spine surgery: a primary care reassessment framework.

Persistent claudication after lumbar spinal surgery may reflect unrecognised peripheral artery disease (PAD) and delayed implementation of secondary cardiovascular prevention. Despite effective guideline-directed therapy, diagnostic and treatment gaps persist in routine practice. Vascular claudication may be under-recognised when exertional lower extremity symptoms are attributed solely to neurogenic causes such as lumbar spinal stenosis. Antiplatelet and statin therapy may be absent even in patients with established PAD, while symptomatic agents such as cilostazol are continued without concurrent secondary prevention. Clinical features supporting vascular rather than neurogenic claudication include reproducible claudication distance, calf-predominant exertional pain, pulse abnormalities, cool extremities and limited posture dependence. Ankle-brachial index (ABI) testing-performed either by Doppler or by validated automated oscillometric devices-provides a practical and guideline-supported first-line diagnostic tool in primary care, with toe-brachial index measurement reserved for patients with non-compressible vessels. This communication provides a primary care reassessment framework integrating symptom-pattern assessment, pulse examination, ABI testing, medication reconciliation and timely vascular referral to reduce diagnostic delay and close secondary prevention gaps in patients with persistent claudication after lumbar spinal surgery. This framework represents a pragmatic clinical approach derived from existing guidelines and observational data; it has not been prospectively validated.