“Peripheral artery disease is the most common vascular condition in India — and one of the least diagnosed. By the time most patients reach me, the disease has been silently progressing for years.”
Written by Dr Rahul Agarwal, Consultant Vascular & Endovascular Surgeon
CARE Hospitals, Banjara Hills, Hyderabad
Peripheral artery disease (PAD) affects millions of Indians, yet most people have never heard of it. Unlike a heart attack — which announces itself loudly — PAD creeps in quietly: a little more leg pain when you walk, a wound that won’t quite heal, feet that feel cold. Then, without warning, a toe turns black. This is how limbs are lost.
Understanding PAD can prevent that from happening to you or someone you love.
🦫 What Is Peripheral Artery Disease?
Peripheral artery disease is the narrowing or blockage of arteries supplying blood to the legs and feet. The cause is almost always atherosclerosis — a buildup of fatty plaque inside the artery wall that progressively reduces blood flow. The same process causes heart attacks (in coronary arteries) and strokes (in carotid arteries). In PAD, it happens in the legs.
The result: the muscles and tissues of the lower leg receive insufficient oxygen-rich blood, particularly during physical activity or in severe cases even at rest.
🚑 Who Gets PAD in India?
PAD is significantly more common in Indians than in many Western populations, for a complex mix of reasons. The major risk factors are:
- Diabetes mellitus — India’s massive diabetic population is the single biggest driver of PAD. Diabetics develop PAD earlier, more severely, and more distally (affecting the small arteries of the foot rather than just the thigh)
- Tobacco smoking and chewing — Nicotine causes intense arterial spasm and accelerates atherosclerosis
- Hypertension — High blood pressure damages artery walls and accelerates plaque formation
- High LDL cholesterol — The fuel for atherosclerotic plaque buildup
- Chronic kidney disease — Patients on dialysis have extremely high PAD rates
🥥 Symptoms: From Mild to Limb-Threatening
Stage 1: Asymptomatic PAD
Many patients have significantly narrowed arteries but no symptoms, particularly if they are relatively inactive. PAD is often discovered incidentally during a routine ABI (ankle-brachial index) check or vascular ultrasound.
Stage 2: Claudication
The classic PAD symptom: cramping, aching, or heaviness in the calf, thigh, or buttock that comes on after a predictable distance of walking and disappears within 1–2 minutes of rest. Patients often find their walking distance gradually decreases over months to years.
Stage 3: Rest Pain
When blockages become severe, the foot starts to hurt even at rest, especially at night. Patients often describe hanging their foot out of bed to get some relief (gravity brings a little more blood down). Rest pain is a sign that the limb is in danger.
Stage 4: Tissue Loss (Ulceration and Gangrene)
The most severe stage: wounds that won’t heal, blackened toes, or frank gangrene. This is critical limb-threatening ischaemia (CLTI). Without urgent revascularisation, amputation becomes necessary.
🔬 How Is PAD Diagnosed?
- Ankle-Brachial Index (ABI) — A simple, painless bedside test comparing blood pressure at the ankle and arm. An ABI below 0.9 confirms PAD. This is the first test and costs very little.
- Duplex Ultrasound — Shows blood flow in arteries non-invasively. The vascular surgeon’s most important first imaging tool.
- CT Angiography — Provides a detailed road map of the arteries from the aorta to the foot. Essential for surgical planning.
- Catheter Angiography — Invasive but allows simultaneous diagnosis and treatment (angioplasty/stenting) in the same sitting.
💉 Treatment Options for PAD
Medical Treatment (All Stages)
- Antiplatelet therapy (aspirin or clopidogrel)
- Statins for cholesterol reduction
- Strict diabetes and blood pressure control
- Absolute smoking cessation
- Supervised exercise therapy for claudication
Endovascular Treatment
- Balloon angioplasty — opening the narrowed artery with a balloon inflated from inside
- Stenting — placing a metal scaffold to keep the artery open
- Drug-coated balloons — reduce the risk of re-narrowing after angioplasty
- Atherectomy — removing plaque from inside the artery with a specialised device
Open Surgical Treatment
- Femoral-popliteal bypass — using the patient’s own vein or a synthetic graft to bypass the blockage
- Femoral-tibial bypass for diabetic foot disease
- Endarterectomy (removing plaque directly from the artery)
❓ Frequently Asked Questions
Is PAD the same as deep vein thrombosis (DVT)?
No. PAD involves arteries (which carry blood from the heart to the legs). DVT involves veins (which return blood from the legs to the heart). They have different causes, symptoms, and treatments.
Can PAD be reversed?
The underlying atherosclerosis cannot be fully reversed, but its progression can be slowed significantly with the right medical treatment. The blockages themselves can be opened with angioplasty or bypassed surgically — restoring blood flow and preventing amputation.
Does PAD mean I will need amputation?
Not at all, if detected and treated early. Most PAD patients with timely intervention keep their limbs. Amputation is a last resort and is now avoidable in the majority of cases with modern revascularisation techniques.
💡 Key Insight: In my practice in Hyderabad, the majority of PAD amputations I see were preventable. The disease was there — but nobody checked for it. If you are diabetic, smoke, have high blood pressure or kidney disease, ask your doctor for an ABI test. It takes 10 minutes and could save your leg.
📖 Related Reading:
- Angioplasty & Stenting for Leg Arteries
- Bypass Surgery for PAD
- When Should You See a Vascular Surgeon?
About the Author 🧑🏻⚕️
Dr Rahul Agarwal is a Consultant Vascular & Endovascular Surgeon at CARE Hospitals, Banjara Hills, Hyderabad, specializing in peripheral artery disease and limb salvage.