{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,25]],"date-time":"2026-08-25T11:23:53Z","timestamp":1787657033494,"version":"build-2736575974"},"reference-count":30,"publisher":"BMJ","issue":"3","license":[{"start":{"date-parts":[[2026,8,25]],"date-time":"2026-08-25T00:00:00Z","timestamp":1787616000000},"content-version":"unspecified","delay-in-days":55,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["Fam Med Com Health"],"accepted":{"date-parts":[[2026,8,19]]},"published-print":{"date-parts":[[2026,7]]},"abstract":"<jats:p>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\u2014performed either by Doppler or by validated automated oscillometric devices\u2014provides 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.<\/jats:p>","DOI":"10.1136\/fmch-2026-004259","type":"journal-article","created":{"date-parts":[[2026,8,25]],"date-time":"2026-08-25T11:10:19Z","timestamp":1787656219000},"page":"e004259","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":0,"title":["Peripheral artery disease in patients with persistent claudication after lumbar spine surgery: a primary care reassessment framework"],"prefix":"10.1136","volume":"14","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-3108-9074","authenticated-orcid":false,"given":"Joomong","family":"Park","sequence":"first","affiliation":[{"name":"Primary Care Division, Sacheon City Public Health Center, Sacheon, South Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2026,8,25]]},"reference":[{"key":"2026082504101066000_14.3.e004259.1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2024.02.013"},{"key":"2026082504101066000_14.3.e004259.2","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(13)61249-0"},{"key":"2026082504101066000_14.3.e004259.3","doi-asserted-by":"crossref","DOI":"10.7189\/jogh.09.010601","article-title":"National and subnational estimation of the prevalence of peripheral artery disease (PAD) in China: a systematic review and meta-analysis","volume":"9","author":"Song","year":"2019","journal-title":"J Glob Health"},{"key":"2026082504101066000_14.3.e004259.4","doi-asserted-by":"publisher","DOI":"10.1038\/nrcardio.2016.179"},{"key":"2026082504101066000_14.3.e004259.5","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCRESAHA.116.303849"},{"key":"2026082504101066000_14.3.e004259.6","doi-asserted-by":"crossref","DOI":"10.1136\/bmjopen-2017-018184","article-title":"Time trends in peripheral artery disease incidence, prevalence and secondary preventive therapy: a cohort study in The Health Improvement Network in the UK","volume":"8","author":"Cea-Soriano","year":"2018","journal-title":"BMJ Open"},{"key":"2026082504101066000_14.3.e004259.7","doi-asserted-by":"publisher","DOI":"10.1001\/jama.286.11.1317"},{"key":"2026082504101066000_14.3.e004259.8","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2017.02.064"},{"key":"2026082504101066000_14.3.e004259.9","first-page":"e726","article-title":"AHA\/ACC guideline on the management of patients with lower extremity peripheral artery disease","volume":"135","author":"Gerhard-Herman","year":"2016","journal-title":"Circulation"},{"key":"2026082504101066000_14.3.e004259.10","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMcp0708097"},{"key":"2026082504101066000_14.3.e004259.11","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCRESAHA.116.303566"},{"key":"2026082504101066000_14.3.e004259.12","doi-asserted-by":"crossref","DOI":"10.1016\/j.jcot.2026.103408","article-title":"Predicting functional impairment in lumbar canal stenosis: Relationship between claudication distance, disability, and neural canal narrowing","volume":"76","author":"Regmi","year":"2026","journal-title":"J Clin Orthop Trauma"},{"key":"2026082504101066000_14.3.e004259.13","doi-asserted-by":"publisher","DOI":"10.1007\/s00776-012-0311-z"},{"key":"2026082504101066000_14.3.e004259.14","doi-asserted-by":"publisher","DOI":"10.1046\/j.1525-1497.2001.016006384.x"},{"key":"2026082504101066000_14.3.e004259.15","doi-asserted-by":"publisher","DOI":"10.1016\/j.jvs.2007.02.004"},{"key":"2026082504101066000_14.3.e004259.16","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCULATIONAHA.110.003954"},{"key":"2026082504101066000_14.3.e004259.17","doi-asserted-by":"publisher","DOI":"10.1093\/eurheartj\/ehae179"},{"key":"2026082504101066000_14.3.e004259.18","doi-asserted-by":"publisher","DOI":"10.1016\/j.cjca.2012.06.014"},{"key":"2026082504101066000_14.3.e004259.19","doi-asserted-by":"crossref","first-page":"365","DOI":"10.1016\/j.atherosclerosis.2010.10.051","article-title":"Exercise ankle brachial index adds important prognostic information on long-term out-come only in patients with a normal resting ankle brachial index","volume":"216","author":"de Liefde","year":"2011","journal-title":"Atherosclerosis"},{"key":"2026082504101066000_14.3.e004259.20","doi-asserted-by":"publisher","DOI":"10.1016\/j.jvs.2013.03.044"},{"key":"2026082504101066000_14.3.e004259.21","doi-asserted-by":"publisher","DOI":"10.1016\/j.jvs.2006.12.037"},{"key":"2026082504101066000_14.3.e004259.22","doi-asserted-by":"publisher","DOI":"10.1345\/aph.1P150"},{"key":"2026082504101066000_14.3.e004259.23","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(96)09457-3"},{"key":"2026082504101066000_14.3.e004259.24","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(17)32409-1"},{"key":"2026082504101066000_14.3.e004259.25","article-title":"Cilostazol for intermittent claudication","volume":"6","author":"Brown","year":"2021","journal-title":"Cochrane Database Syst Rev"},{"key":"2026082504101066000_14.3.e004259.26","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCULATIONAHA.117.032361"},{"key":"2026082504101066000_14.3.e004259.27","article-title":"Reassessment of long-term guideline-directed therapy for peripheral arterial occlusive disease in primary care","volume":"18","author":"Park","year":"2026","journal-title":"Cureus"},{"key":"2026082504101066000_14.3.e004259.28","doi-asserted-by":"crossref","first-page":"807","DOI":"10.1093\/pm\/pnab015","article-title":"Persistent spinal pain syndrome: a proposal for failed back surgery syndrome and ICD-11","volume":"22","author":"Christelis","year":"2021","journal-title":"Pain Med"},{"key":"2026082504101066000_14.3.e004259.29","doi-asserted-by":"crossref","first-page":"814","DOI":"10.1007\/s00586-015-4102-z","article-title":"Efficacy of ankle-brachial index as a preoperative screening in spine surgery","volume":"25","author":"Tanaka","year":"2016","journal-title":"Eur Spine J"},{"key":"2026082504101066000_14.3.e004259.30","doi-asserted-by":"crossref","DOI":"10.1186\/s12891-022-06066-2","article-title":"Risk factors for failed back surgery syndrome following open posterior lumbar surgery for degenerative lumbar disease","volume":"23","author":"Xu","year":"2022","journal-title":"BMC Musculoskelet Disord"}],"container-title":["Family Medicine and Community Health"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/fmch-2026-004259","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,25]],"date-time":"2026-08-25T11:10:22Z","timestamp":1787656222000},"score":1,"resource":{"primary":{"URL":"https:\/\/fmch.bmj.com\/lookup\/doi\/10.1136\/fmch-2026-004259"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,7]]},"references-count":30,"journal-issue":{"issue":"3","published-online":{"date-parts":[[2026,8,25]]},"published-print":{"date-parts":[[2026,7]]}},"alternative-id":["10.1136\/fmch-2026-004259"],"URL":"https:\/\/doi.org\/10.1136\/fmch-2026-004259","relation":{},"ISSN":["2305-6983","2009-8774"],"issn-type":[{"value":"2305-6983","type":"print"},{"value":"2009-8774","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,7]]}}}