Peripheral Arterial Disease (PAD)

What is Peripheral Arterial Disease (PAD)?

Peripheral Arterial Disease (PAD) is a common but serious circulatory condition in which the arteries that carry blood to the legs, feet, and sometimes the arms become narrowed or blocked. This restricted blood flow deprives the extremities of the oxygen and nutrients they need, potentially causing pain, difficulty walking, and in severe cases, tissue death that may require amputation.

PAD affects approximately 8.5 million Americans and is most common in men and women over age 50, affecting 12-20% of adults aged 65 and older [1]. Despite its prevalence, PAD is significantly underdiagnosed — many people attribute their symptoms to normal aging rather than recognizing them as signs of a treatable vascular condition.

What Causes PAD?

The most common cause of PAD is atherosclerosis, often called “hardening of the arteries.” Atherosclerosis is a gradual process in which cholesterol, fat, calcium, and scar tissue build up on the inner walls of arteries, forming deposits called plaque. As plaque accumulates, the blood flow channel narrows, restricting the delivery of oxygen and nutrients to tissues downstream.

Over time, atherosclerotic arteries also lose their natural elasticity, becoming rigid and less able to respond to the body’s changing needs during physical activity. In some cases, plaque can rupture and trigger a blood clot that further restricts or completely blocks blood flow. Left untreated, this insufficient blood flow can lead to serious complications, including chronic wounds, gangrene, and limb amputation.

PAD is also a warning sign of widespread atherosclerosis. Patients diagnosed with PAD are significantly more likely to have blockages in other arteries, putting them at increased risk for heart attack and stroke. This is why early diagnosis and comprehensive vascular care are so important.

Symptoms of PAD

PAD develops gradually, and many people have the disease without knowing it. Symptoms depend on the severity and location of arterial blockages:

Early Symptoms

• Claudication: The most common symptom — cramping, pain, or fatigue in the leg muscles (calves, thighs, or hips) that occurs during walking or exercise and goes away with rest. Many people dismiss this as simply being “out of shape.”
• Numbness or tingling in the lower legs and feet
• Coldness in the lower leg or foot, especially compared to the other leg
• Reduced hair growth on the legs
• Slower toenail growth

Advanced Symptoms

As PAD progresses, symptoms may become more severe:

• Pain in the legs or feet at rest, particularly at night while lying down
• Non-healing sores or wounds on the toes, feet, or legs
• Skin color changes — the affected leg may appear pale, bluish, or reddish
• Shiny, smooth skin on the legs
• Weak or absent pulses in the legs or feet
• Erectile dysfunction in men
• Gangrene (tissue death) in severe cases

Critical Limb Ischemia

The most severe form of PAD is critical limb ischemia (CLI), characterized by chronic rest pain, non-healing wounds, and tissue loss. CLI requires urgent medical attention to prevent amputation.

Risk Factors

Several factors significantly increase your risk of developing PAD:

• Smoking — the single most important modifiable risk factor. Smokers are up to four times more likely to develop PAD [2].
• Diabetes — high blood sugar damages artery walls and accelerates atherosclerosis. People with diabetes are two to four times more likely to develop PAD.
• High blood pressure — damages artery walls over time and promotes plaque buildup
• High cholesterol — contributes directly to plaque formation in the arteries
• Age — risk increases significantly after age 50
• Family history of PAD, heart disease, or stroke
• Obesity — increases cardiovascular strain and contributes to other risk factors
• Sedentary lifestyle — lack of exercise weakens the cardiovascular system
• Chronic kidney disease — associated with accelerated atherosclerosis
• Race — Black Americans have a higher prevalence of PAD

Having multiple risk factors compounds your overall risk. If you have two or more of these risk factors, screening for PAD is recommended.

Diagnosis

Early diagnosis of PAD is straightforward and painless. At Preferred Vascular Group, we use several diagnostic methods:

Ankle-Brachial Index (ABI)

The ABI is the most common initial screening test for PAD. This simple, painless exam uses ultrasound to compare blood pressure measurements taken at the ankle and the arm. A low ratio indicates reduced blood flow to the legs, suggesting arterial blockages. The ABI can detect PAD even before symptoms develop.

Additional Diagnostic Tests

Based on ABI results, symptoms, and risk factors, additional testing may include:

• Duplex Ultrasound: Uses sound waves to visualize blood flow through the arteries and pinpoint the location and severity of blockages.
• CT Angiography (CTA): Provides detailed, three-dimensional images of the arteries using contrast dye and advanced imaging.
• Magnetic Resonance Angiography (MRA): Creates detailed images of blood vessels using magnetic fields, without ionizing radiation.
• Angiography: A minimally invasive procedure in which contrast dye is injected directly into the arteries to identify blockages in real time. This can also be combined with treatment in the same session.

Treatment Options

Treatment for PAD depends on the severity of the disease and the patient’s overall health. The goals are to relieve symptoms, improve mobility, and reduce the risk of heart attack, stroke, and limb loss.

Lifestyle Changes

For early-stage PAD, lifestyle modifications are the foundation of treatment and can significantly improve symptoms:

• Quit smoking — the single most important step. If you need help, talk to your doctor about cessation programs and medications.
• Supervised exercise program — regular walking has been shown to dramatically improve walking distance and reduce claudication symptoms. A structured program of 30-45 minutes of walking, three to five times per week, is often recommended.
• Heart-healthy diet — low in saturated fat, sodium, and processed foods; rich in fruits, vegetables, whole grains, and lean proteins.
• Manage blood pressure and cholesterol — medications may be needed to achieve healthy levels.
• Control blood sugar — if you have diabetes, keeping glucose in a target range helps protect your arteries.
• Maintain a healthy weight — reduces cardiovascular strain and improves overall vascular health.

Medications

Your doctor may prescribe medications to:

• Lower cholesterol (statins)
• Control blood pressure
• Prevent blood clots (antiplatelet medications such as aspirin or clopidogrel)
• Improve walking distance (cilostazol)
• Manage diabetes

Minimally Invasive Procedures

When lifestyle changes and medications are not sufficient, our vascular specialists offer advanced, minimally invasive treatments to restore blood flow:

• Angioplasty with Stenting: A catheter with a small balloon is guided to the blocked artery. The balloon is inflated to compress the plaque and open the artery. A stent (small mesh tube) may be placed to keep the artery open.
• Atherectomy: A specialized catheter with a cutting or grinding device is used to physically remove plaque from inside the artery, restoring normal blood flow. Atherectomy is particularly effective for calcified or complex lesions.

These procedures are typically performed on an outpatient basis through a small puncture in the skin, with no surgical incision required. Most patients return to normal activities within a few days.

Living with PAD

Managing PAD is an ongoing commitment. Even after successful treatment, it is important to:

• Continue taking prescribed medications
• Maintain an active lifestyle with regular walking
• Attend follow-up appointments to monitor arterial health
• Perform daily foot and leg checks for wounds, color changes, or temperature differences
• Keep all risk factors well-controlled
• Report any new or worsening symptoms promptly

Why Choose Preferred Vascular Group?

At Preferred Vascular Group, our board-certified vascular specialists have extensive experience diagnosing and treating PAD at all stages. We offer:

• Simple, painless screening with ankle-brachial index testing
• Advanced diagnostic imaging to accurately assess the extent of disease
• Minimally invasive treatments including angioplasty, stenting, and atherectomy
• Comprehensive risk factor management to slow disease progression
• Coordinated care with your primary care physician and other specialists
• Eight convenient locations across Georgia and Ohio

PAD is a treatable condition, and early intervention can prevent serious complications. If you are experiencing leg pain during walking, have non-healing wounds, or have risk factors for vascular disease, our specialists can provide a thorough evaluation and personalized treatment plan.

References

1. Criqui MH, Aboyans V. “Epidemiology of peripheral artery disease.” Circulation Research, 2015. PubMed
2. Peripheral Arterial Disease. StatPearls, StatPearls Publishing, 2024. NCBI Bookshelf
3. Gerhard-Herman MD, et al. “2016 AHA/ACC guideline on the management of patients with lower extremity peripheral artery disease.” Circulation, 2017. PubMed
4. Ankle Brachial Index. StatPearls, StatPearls Publishing, 2024. NCBI Bookshelf