Peripheral Artery Disease (PAD)
Expert diagnosis and minimally invasive treatment in Hyderabad — Dr Rahul Agarwal, Consultant Vascular Surgeon, CARE Hospitals Banjara Hills
What is Peripheral Artery Disease?
Peripheral artery disease (PAD) is a condition in which the arteries supplying blood to the legs become narrowed or blocked. This usually happens because of a gradual buildup of fatty deposits within the walls of the blood vessels, a process known as atherosclerosis.
When the arteries become narrowed, blood flow to the muscles and tissues of the legs is reduced. As a result, the tissues do not receive enough oxygen and nutrients, especially during physical activity such as walking.
In the early stages, many people do not notice any symptoms. As the disease progresses, patients experience pain in the legs while walking, delayed wound healing, or skin colour and temperature changes.
PAD can affect arteries in:
- thighs
- calves
- feet
- pelvis
In severe cases, blood flow becomes critically reduced, leading to chronic limb threatening ischaemia (CLTI), ulcers, or gangrene.
Peripheral artery disease is one of the most common vascular conditions affecting adults, particularly individuals with diabetes, smoking history, high blood pressure, or high cholesterol.
Why Peripheral Artery Disease is Important
Peripheral artery disease is not simply a circulation problem in the legs. It is often a sign of a more widespread process of atherosclerosis affecting blood vessels throughout the body.
Patients with PAD may also have narrowing of arteries supplying the heart or brain, which increases the risk of serious cardiovascular events such as heart attack and stroke. Learn how dangerous untreated PAD can be →
The encouraging aspect is that with early diagnosis and proper treatment, the progression of the disease can often be slowed or controlled, and serious complications avoided.
Common Symptoms of Peripheral Artery Disease
The most common symptom is claudication — pain or cramping in the leg muscles while walking that improves with rest. Other symptoms include:
- fatigue or heaviness in the legs during walking
- pain in the calf, thigh, or buttock muscles
- pain in the foot or toes while resting, particularly at night in advanced disease
- wounds or ulcers on the foot that do not heal
- coldness in one foot compared to the other
- colour changes in the skin of the foot or toes
- reduced hair growth or shiny skin on the legs
Risk Factors for Peripheral Artery Disease
Smoking – Damages the inner lining of blood vessels and significantly accelerates atherosclerosis.
Diabetes – High blood sugar damages blood vessels and nerves, increasing circulation problems in the legs and feet.
High blood pressure – Long-standing hypertension places additional stress on artery walls.
High cholesterol – Elevated cholesterol promotes plaque formation inside blood vessels.
Increasing age – PAD becomes more common after the age of 50.
Obesity and sedentary lifestyle – Lack of physical activity and excess weight increase cardiovascular risk.
Among these, smoking and diabetes remain the strongest contributors to severe peripheral artery disease.
How Peripheral Artery Disease is Diagnosed
Ankle-Brachial Index (ABI) — A simple non-invasive test comparing blood pressure in the ankle with blood pressure in the arm.
Doppler Ultrasound — Visualises blood flow in the arteries and identifies areas of narrowing or blockage. Usually the first test your vascular surgeon orders.
CT Angiography or MR Angiography — Detailed imaging of blood vessels to plan treatment.
Catheter Angiography — Performed when an endovascular procedure is being considered simultaneously.
Treatment Options for Peripheral Artery Disease
1. Medical Management and Lifestyle Measures
- quitting smoking
- regular walking exercise programmes
- good control of diabetes
- treatment of high blood pressure and cholesterol
- medications that improve blood flow and reduce cardiovascular risk
2. Endovascular Treatment
Angioplasty and stenting – A small balloon widens the narrowed artery; a stent keeps it open.
Atherectomy – Specialised devices remove plaque from the artery.
Drug-coated balloon angioplasty – A drug that slows disease progression is delivered at the site of blockage alongside angioplasty.
3. Surgical Treatment
In some patients, particularly when blockages are extensive, surgical treatment may be required. Arterial bypass surgery redirects blood flow around the blocked artery using a graft (natural vein or synthetic). Endarterectomy involves surgically removing the blockage and repairing the artery with a patch. Hybrid procedures combining surgical and endovascular techniques may also be used in selected cases.
Warning Signs that Require Urgent Medical Attention
- sudden severe pain in the leg or foot
- blackening or discoloration of toes
- wounds on the foot that do not heal
- severe pain in the foot while resting
- sudden loss of pulses or temperature change in the limb
These may indicate critical limb ischaemia — a severe form of reduced blood circulation requiring urgent treatment.
Frequently Asked Questions
What causes peripheral artery disease?
Most commonly atherosclerosis — a buildup of fatty deposits inside artery walls that narrows blood vessels and reduces flow to the legs. Smoking, diabetes, high blood pressure, and high cholesterol significantly increase the likelihood.
Can peripheral artery disease be treated without surgery?
Yes. Many patients are initially managed with lifestyle modifications and medications. Learn about non-surgical PAD treatment options → When symptoms become severe or wounds fail to heal, minimally invasive endovascular procedures or surgery may be needed to restore blood flow.
Is walking good for PAD?
Yes. Regular supervised walking exercise helps improve circulation and reduces symptoms. Walking distance gradually improves and quality of life increases significantly. A surgeon’s complete guide to exercising with PAD →
Can PAD lead to amputation?
In severe untreated cases, PAD can lead to ulcers, gangrene, and amputation. Early treatment and vascular evaluation significantly reduces this risk.
When Should You See a Vascular Surgeon?
- pain in the legs while walking that improves with rest
- wounds on the foot that do not heal
- discoloration or blackening of toes
- persistent coldness in the foot
- severe pain in the foot while resting
- sudden worsening of circulation symptoms
Book a Consultation with Dr Rahul Agarwal
CARE Hospitals, Road No. 10, Banjara Hills, Hyderabad · Mon–Sat, 10 AM–4 PM
Medically authored and reviewed by
Dr Rahul Agarwal
Consultant Vascular & Endovascular Surgeon, CARE Hospitals, Banjara Hills, Hyderabad
MBBS · DNB (General Surgery) · DrNB (Vascular Surgery)
Related Reading
- Angioplasty & Stenting for Leg Arteries — What to Expect
- Bypass Surgery for PAD: Femoral-Popliteal & Beyond
- What to Expect After Angioplasty or Bypass Surgery for PAD
- Can You Exercise With Peripheral Artery Disease? A Surgeon’s Guide
- Vascular Ultrasound: The First Test Your Vascular Surgeon Orders
- Venous Ulcer vs Arterial Ulcer vs Diabetic Ulcer: How to Tell the Difference
- Diabetic Foot: Causes, Symptoms, Prevention and Treatment