Peripheral artery disease — or PAD — is one of those conditions that quietly does enormous damage before most people know they have it. As a vascular surgeon, I see the consequences of undiagnosed PAD every week: non-healing wounds, limb-threatening infections, and patients told that amputation may be their only option. Most of this is preventable. Understanding what PAD is — and recognising it early — is the first step.
What Is Peripheral Artery Disease?
Peripheral artery disease (PAD) is a circulatory condition in which the arteries supplying blood to the legs — and sometimes the arms — become narrowed or blocked due to a build-up of fatty plaques inside the artery wall. This process, called atherosclerosis, reduces blood flow to the muscles and tissues of the limb. When the limb does not receive enough oxygenated blood, it cannot function normally, and eventually, tissue begins to die.
PAD is extremely common — it affects over 200 million people worldwide, and India carries a significant share of this burden due to the high prevalence of diabetes, hypertension, and smoking in the population. Despite its prevalence, PAD is dramatically underdiagnosed because many patients have no symptoms until the disease is advanced.
What Causes Peripheral Artery Disease?
PAD is caused by atherosclerosis — the same process that causes heart attacks and strokes, but occurring in the arteries of the legs. Atherosclerosis begins when cholesterol, calcium, and inflammatory cells accumulate in the inner lining of arteries, forming plaques that progressively narrow the vessel. Over time, plaques can become severe enough to critically restrict or completely block blood flow.
The risk factors that accelerate atherosclerosis and cause PAD are well established: smoking, diabetes, high blood pressure, high cholesterol, obesity, physical inactivity, and advancing age. Of these, smoking and diabetes are the most powerful drivers of PAD — particularly in Indian patients.
Which Arteries Are Affected in PAD?
In the legs, PAD most commonly affects the arteries of the thigh (superficial femoral artery), the knee (popliteal artery), and the calf vessels (tibial arteries). Diabetic patients tend to have more severe disease in the smaller calf and foot arteries, which is why they are at particularly high risk of non-healing foot wounds and limb loss.
PAD can also affect the aorta and iliac arteries higher up in the abdomen and pelvis, causing buttock or thigh pain on walking rather than calf pain.
How Does PAD Progress?
- Asymptomatic PAD — arteries are narrowed but collateral vessels compensate; no symptoms yet, but detectable on Doppler examination
- Claudication — cramping pain in the calf, thigh, or buttock during walking that relieves with rest; caused by muscle ischaemia during exertion
- Rest pain — pain in the foot at rest, particularly at night; a sign of severely reduced circulation
- Critical limb ischaemia (CLI) — rest pain combined with tissue loss (ulcers or gangrene); the most severe form of PAD, associated with high risk of amputation and death
Is PAD Related to Heart Disease?
Yes — significantly. Patients with PAD have the same atherosclerotic process affecting their coronary arteries and carotid arteries. The presence of PAD is an independent marker of increased risk of heart attack and stroke. Treating PAD is therefore not just about saving the leg — it is also about identifying a patient at high cardiovascular risk who needs comprehensive medical management.
My Clinical Perspective
In my practice, I find that patients with PAD often attribute their leg symptoms to ageing, arthritis, or general unfitness. Calf pain on walking is dismissed as a muscle problem. Cold feet are accepted as normal. By the time someone presents with a non-healing wound or gangrene, significant and irreversible damage has often already occurred. PAD is a disease that rewards early suspicion and early referral. If you or someone you know has risk factors for PAD — diabetes, smoking, hypertension — a simple Doppler test at a vascular clinic can tell you whether your leg arteries are healthy.
Warning Signs of PAD That Should Not Be Ignored
- Cramping, aching, or heaviness in the calf, thigh, or buttock when walking — relieved by rest
- Cold or numb feet, especially one foot colder than the other
- Pale, bluish, or shiny skin on the legs or feet
- Slow-growing or absent toenails; loss of leg hair
- Wounds on the feet or toes that are not healing
- Pain in the foot at rest or at night
- Black or gangrenous tissue on a toe or the foot
⚠️ Important: PAD is frequently silent until it is severe. Anyone over 50 with diabetes, hypertension, or a history of smoking should ask their doctor about a vascular screening assessment.
→ Read more: Peripheral Artery Disease — Full Specialty Page
Frequently Asked Questions About PAD
Is peripheral artery disease the same as peripheral vascular disease?
The terms are often used interchangeably, but peripheral vascular disease (PVD) is the broader term — it includes diseases of both arteries and veins. Peripheral artery disease specifically refers to arterial narrowing due to atherosclerosis. In clinical practice, when doctors say PAD, they mean the arterial form.
Can PAD affect young people?
PAD is more common over 50, but younger patients with diabetes, heavy smoking history, or rare conditions like Buerger’s disease (thromboangiitis obliterans) can develop significant arterial disease in their 30s and 40s. In India, Buerger’s disease in young male smokers is an important cause of limb loss.
Is PAD curable?
PAD is not curable in the sense of reversing all arterial damage, but it is highly treatable. Risk factor modification (stopping smoking, controlling diabetes, statins, blood pressure management) slows progression significantly. Angioplasty and bypass surgery can restore blood flow where blockages are critical. Many patients with PAD live well for decades with appropriate management.
What is the ankle-brachial index (ABI) test for PAD?
The ABI is a simple, non-invasive test that compares blood pressure at the ankle with blood pressure at the arm. A normal ABI is 1.0–1.4. An ABI below 0.9 indicates PAD. The test takes about 15 minutes, requires no needles, and is performed in a vascular clinic using a Doppler probe and blood pressure cuff.
If you have risk factors for PAD or are experiencing leg symptoms, I offer comprehensive vascular assessment including Doppler ultrasound at CARE Hospitals, Banjara Hills, Hyderabad.
Dr Rahul Agarwal is a Consultant Vascular & Endovascular Surgeon at CARE Hospitals, Banjara Hills, Hyderabad (MS, DNB). He specialises in peripheral artery disease, endovascular angioplasty, bypass surgery, and critical limb salvage.
Medical Disclaimer: This article is for educational purposes only and does not constitute medical advice. Please consult a qualified medical professional for diagnosis and treatment of any health condition.