Peripheral Artery Disease (PAD)
Atherosclerotic narrowing of the limb arteries, causing pain on walking and risk of limb loss.
Overview
PAD is atherosclerosis of the arteries supplying the limbs, most commonly the legs. It causes intermittent claudication and, when severe, critical limb-threatening ischaemia. PAD is a marker of systemic atherosclerosis and high cardiovascular risk.
Symptoms
- • Cramping leg pain on walking, relieved by rest (claudication)
- • Cold, pale or hairless legs
- • Slow-healing foot wounds or ulcers
- • Rest pain (worse at night, relieved by hanging legs down)
- • Gangrene in advanced disease
Risk factors
- • Smoking (strongest modifiable risk factor)
- • Diabetes
- • Hypertension and dyslipidaemia
- • Age >65
- • Chronic kidney disease
- • Family history of cardiovascular disease
Causes
- • Atherosclerosis (overwhelmingly the cause)
- • Rarer: thromboangiitis obliterans, vasculitis, fibromuscular dysplasia
🚨 Red flags — seek urgent care
- • Sudden cold, pale, painful leg — acute limb ischaemia, emergency
- • Black or non-healing toe ulcer
- • Rest pain at night
When to seek care
- • New claudication or change in walking distance
- • Any non-healing foot wound, especially in diabetes
- • Sudden severe leg pain — emergency
Diagnosis
- • Ankle-brachial pressure index (ABPI) — <0.9 diagnostic
- • Duplex ultrasound, CT or MR angiography to map disease
- • Cardiovascular risk assessment: lipids, HbA1c, BP
Treatment
- • Stop smoking — single most effective intervention
- • Supervised exercise programme for claudication
- • Antiplatelet (clopidogrel or aspirin) and high-intensity statin
- • Optimise BP and diabetes; consider rivaroxaban 2.5 mg bd plus aspirin in selected cases
- • Revascularisation (angioplasty/stent or bypass) for disabling or limb-threatening disease
Prevention
- • Never smoke; if you smoke, stop
- • Tight control of BP, lipids and glucose
- • Regular exercise and Mediterranean-style diet
- • Foot care in diabetes
Complications
- • Critical limb ischaemia and amputation
- • Myocardial infarction and stroke (shared atherosclerosis)
- • Non-healing ulcers and infection
Prognosis
PAD itself is rarely directly fatal but signals high cardiovascular risk: 5-year mortality is ~20%, mostly from heart attack or stroke. Aggressive risk-factor control significantly improves outlook.
Education & self-care
PAD is a sign of widespread atherosclerosis. Stopping smoking, walking regularly and treating risk factors transform outcomes.
Frequently asked questions
Do I need surgery?
Most people improve with exercise and medication. Surgery or stenting is reserved for disabling claudication or limb-threatening disease.
Why does my doctor focus on my heart if my legs hurt?
PAD is a marker of atherosclerosis throughout the body. Most people with PAD die of heart attack or stroke, so cardiovascular protection is central.
What is intermittent claudication?
Cramp-like leg pain on walking that eases within minutes of rest, caused by inadequate blood flow through narrowed arteries. It is the most common symptom of peripheral artery disease.
Does supervised exercise really help?
Yes — supervised exercise programmes typically double walking distance and are at least as effective as angioplasty for stable claudication, without procedural risk.
When is surgery needed?
Critical limb ischaemia (rest pain, ulcers, gangrene) needs urgent vascular referral for revascularisation — angioplasty, stent or bypass — to prevent limb loss.