Know about Peripheral Artery Disease | Max Hospital

Peripheral Artery Disease: All You Need to Know

By Dr. Achintya Sharma in Vascular Surgery

Feb 27 , 2024 | 14 min read

Peripheral artery disease (PAD) is a silent yet formidable threat to vascular health, affecting millions worldwide, and can lead to a range of symptoms from intermittent claudication to more severe complications such as critical limb ischemia. In this article, we delve into the intricacies of PAD, exploring its causes, symptoms, diagnostic procedures, and available treatment options, with an aim to help the readers mitigate its effects. Join us on this informative journey to unravel the complexities of this disorder, and empower yourself to make informed decisions about identifying and dealing with PAD. Let's start with the basics. 

What is Peripheral Artery Disease?

Peripheral Artery Disease (PAD), also called Peripheral Vascular Disease (PVD) and Peripheral Artery Occlusive Disease (PAOD), is a common circulatory problem, characterised by narrowing of arteries, which results in reduced blood flow to the limbs, usually the legs, eventually leading to death of tissue. Given the criticality, it's important for individuals, especially those with risk factors, to be aware of the symptoms of PAD and seek medical attention if they experience any concerning signs. Early diagnosis and a comprehensive approach to management can significantly impact the progression of the disease and improve overall health.

What are the Risk Factors for Peripheral Artery Disease?

If anyone has any of the risk factors mentioned below for more than 6 months, it is recommended to consult a cardiovascular doctor as soon as possible:

Diagnosis will be delayed or missed in patients with conditions that limit mobility as symptoms will not manifest:

What are the Symptoms of Peripheral Artery Disease?

Peripheral artery disease can produce a variety of symptoms, and the severity of symptoms often depends on the stage of the disease. The most common symptom of PAD is intermittent claudication, which is pain, cramping, or discomfort in the muscles of the legs or arms during physical activity. Here are the typical symptoms of peripheral artery disease:

  • Intermittent claudication: Pain, cramping, or fatigue in the muscles of the legs or buttocks during physical activity, such as walking or climbing stairs. The pain typically subsides with rest and returns when the physical activity is resumed.
  • Pain at rest: In more advanced stages of PAD, individuals may experience pain or discomfort even at rest, especially when lying down. This pain often occurs in the toes, feet, or lower legs and can be severe, affecting sleep and quality of life.
  • Non-healing wounds and ulcers: Poor blood flow can lead to delayed healing of wounds and the development of ulcers, especially on the feet and toes. Chronic ulcers may become infected and pose a risk of complications.
  • Coldness or numbness: Reduced blood flow can lead to sensations of coldness or numbness in the affected limbs. Individuals may notice that the affected extremities feel cooler than the rest of the body.
  • Skin changes: Changes in skin colour, such as paleness or a bluish tint (cyanosis), may occur. Shiny or thin skin, as well as hair loss on the legs, can be indicative of reduced blood flow.
  • Weakened pulse: A healthcare professional may detect a weakened or absent pulse in the affected limb during a physical examination.
  • Erectile dysfunction: PAD can affect blood flow to the genital area, leading to erectile dysfunction in men.

It's important to note that some individuals with PAD may not experience noticeable symptoms, especially in the early stages. This is why PAD is often referred to as a "silent" disease. However, even in the absence of symptoms, the underlying arterial disease can progress and increase the risk of complications.

What are the Stages of Peripheral Artery Disease?

Peripheral Artery Disease is often classified into different stages based on the severity of the condition. The most commonly used classification system is the Rutherford classification used to assess the extent of arterial disease and determine appropriate treatment approaches. It's worth noting that there is also a similar classification known as the Fontaine classification, which is commonly used in Europe. Below is an overview of the Rutherford classification:

Stage 0 - Asymptomatic

  • No symptoms are present
  • Arterial disease is detected through diagnostic tests, such as Doppler ultrasound or angiography, but the individual does not experience symptoms like pain or discomfort during physical activity.

Stage I - Mild claudication

  • The primary symptom is intermittent claudication, which refers to pain, cramping, or fatigue in the muscles of the affected limb (usually the calf, thigh, or buttock) during physical activity.
  • Symptoms are generally relieved with rest.
  • The individual can usually walk a certain distance before symptoms occur.

Stage II - Moderate claudication

  • Claudication symptoms become more pronounced.
  • Walking distance is further limited, and symptoms may occur with less physical activity.
  • Resting provides relief from symptoms.

Stage III - Severe claudication

  • Pain or discomfort occurs at shorter walking distances.
  • Symptoms may interfere with daily activities and quality of life.
  • Pain relief may take longer with rest.

Stage IV - Critical Limb Ischemia (CLI)

  • Severe obstruction of blood flow leads to rest pain (pain at rest) in the affected limb.
  • Non-healing wounds, ulcers, or gangrene may develop.
  • CLI represents a more advanced stage with an increased risk of limb loss.

Stage V - Minor Tissue Loss

  • The presence of minor tissue loss, such as small ulcers or sores.
  • The tissue loss may not be extensive, and the affected limb may still be salvageable with appropriate intervention.

Stage VI - Major tissue loss

  • Extensive tissue loss, often involving large ulcers or gangrene.
  • The risk of limb loss is high without prompt and effective treatment.

It's important to note that not all individuals with PAD progress through all these stages, and the severity of the disease can vary from person to person. 

What are the Complications of Peripheral Artery Disease?

Peripheral Artery Disease (PAD) can lead to several complications, especially when the disease is not effectively managed or in more advanced stages. The reduced blood flow associated with PAD can have significant consequences for the affected limbs and overall health. Here are some potential complications:

  • Critical Limb Ischemia (CLI): Critical limb ischemia is an advanced stage of PAD, characterised by severe blockages in the arteries, leading to insufficient blood flow to the affected limb. Symptoms include rest pain (pain at rest), non-healing wounds, and ulcers. If not treated promptly and effectively, CLI poses a significant risk of limb loss.
  • Non-healing wounds and ulcers: Poor blood flow in PAD can result in slow wound healing and the development of ulcers, particularly on the feet. Chronic wounds and ulcers may become infected, increasing the risk of complications.
  • Infections: Reduced blood flow compromises the body's ability to fight infections effectively. Infections in the affected limbs, especially in the presence of wounds or ulcers, can lead to cellulitis or more severe complications.
  • Gangrene: Gangrene is the death of body tissue resulting from a lack of blood supply. It is a serious condition that may require surgical intervention and, in extreme cases, amputation to prevent the spread of infection. Severe cases of PAD, particularly in combination with infections, can lead to gangrene.
  • Amputation: In cases where blood flow is severely compromised, and complications such as gangrene are present, amputation of the affected limb may be necessary to save the individual's life and prevent the spread of infection.
  • Cardiovascular complications: PAD is associated with an increased risk of other cardiovascular diseases, including heart attack and stroke. The atherosclerotic process that leads to PAD can affect arteries throughout the body, contributing to a systemic cardiovascular risk.
  • Reduced quality of life: The symptoms of PAD, such as claudication and pain, can significantly impact an individual's ability to perform daily activities and maintain a good quality of life.

When to Visit a Vascular Surgeon?

Target Organ

Artery Location




  • Stroke
  • Blindness
  • Transient ischemic attack



  • Pain in the abdomen especially after meals.
  • Gangrene of intestines (This is an Emergency)



  • Hypertension
  • Decreasing kidney function


Arm, Leg

  • Pain on working, walking
  • Pain at rest
  • Blue/Black toes
  • Gangrene

It is expected that 20% of the population above 65 years will have this condition while 30% diabetes patients are at a higher risk of having stroke and heart attack. Thus, diagnosing them is very critical. 

How is Peripheral Artery Disease Diagnosed?

The diagnosis of peripheral artery disease involves a combination of medical history assessment, physical examination, and various diagnostic tests. Doctors use these tools to evaluate the extent and severity of arterial blockages and determine the most appropriate treatment approach. Common diagnostic methods for PAD include:

  • Medical history and physical examination: The healthcare provider will inquire about symptoms, risk factors, and the patient's overall health history. Physical examination may include checking for pulses in the affected limbs, assessing skin colour and temperature, and examining for signs of wounds or ulcers.
  • Ankle-Brachial Index (ABI): ABI is a non-invasive test that compares blood pressure measurements in the arms and ankles. A lower ABI in one or both legs compared to the arms may indicate reduced blood flow and is suggestive of PAD.
  • Doppler ultrasound: Doppler ultrasound uses sound waves to create images of blood flow in the arteries. It can help identify the location and severity of arterial blockages and assess blood flow velocity.
  • Segmental pressure measurements: This test involves measuring blood pressure at various segments of the affected limb using cuffs placed along the leg. Segmental pressure measurements help localise the site of arterial blockages.
  • Pulse Volume Recordings (PVR): PVR is another non-invasive test that measures blood volume changes in the limbs during each heartbeat. Abnormal PVR patterns may indicate arterial blockages.
  • Angiography: Angiography is an imaging test that involves injecting a contrast dye into the arteries, followed by X-ray imaging. This procedure provides detailed images of the arterial blood vessels and helps identify the location and severity of blockages.
  • Magnetic Resonance Angiography (MRA): MRA uses magnetic fields and radio waves to create detailed images of blood vessels. It is a non-invasive alternative to angiography and can provide information about the structure of the arteries.
  • Computed Tomography Angiography (CTA): CTA involves the use of X-rays and computer technology to create detailed cross-sectional images of blood vessels. It can help visualise the extent and location of arterial blockages.
  • Blood tests: Blood tests may be conducted to assess cholesterol levels, blood glucose, and other factors that contribute to the development and progression of PAD.
  • Treadmill exercise test: In some cases, a treadmill exercise test may be used to assess symptoms of claudication and determine the extent of functional impairment.

The choice of diagnostic tests depends on the patient's symptoms, medical history, and the suspected severity of PAD. These tests help healthcare professionals tailor a treatment plan to address the specific needs of the individual.

How is Peripheral Artery Disease Treated?

Peripheral artery disease is managed through a combination of lifestyle changes, medications, and, in some cases, interventional procedures or surgery. Here is an overview of the treatment approaches for PAD:

Lifestyle modifications

  • Smoking cessation: Quitting smoking is crucial, as smoking is a major risk factor for PAD and can worsen symptoms.
  • Exercise: Regular physical activity, particularly walking, can improve symptoms of claudication and increase overall cardiovascular health. A structured exercise program should be developed in consultation with a healthcare professional.
  • Heart-healthy diet: Adopting a heart-healthy diet low in saturated fats, cholesterol, and sodium is essential. A diet rich in fruits, vegetables, whole grains, and lean proteins is recommended.


  • Antiplatelet medications: Aspirin or other antiplatelet medications may be prescribed to reduce the risk of blood clot formation and improve blood flow.
  • Cholesterol-lowering medications: Statins and other lipid-lowering medications help manage high cholesterol levels, which contribute to atherosclerosis.
  • Blood pressure medications: Controlling hypertension is crucial for managing PAD. Medications such as ACE inhibitors or ARBs may be prescribed.
  • Medications for symptom relief: Cilostazol is a medication that may be prescribed to improve walking distance and alleviate symptoms of intermittent claudication.

Revascularization procedures

These procedures are done to increase the blood supply to the target organ to prevent organ deaths:

  • Angioplasty: During angioplasty, a catheter with a balloon is used to open narrowed arteries. In some cases, a stent may be placed to keep the artery open.
  • Stent placement: Stents are mesh-like tubes that are inserted into the arteries to provide structural support and maintain blood flow.
  • Endarterectomy: This procedure involves removing the plaque from the inside of the artery. It involves inserting a specialised surgical tool into a blocked artery to clear up a buildup.
  • Atherectomy: Drilling or laser ablation through the block and making the blood vessel diameter wider.
  • Amputation: This is one of the most common procedures as the patient can have delayed presentations and limbs are not salvageable at all times they reach the vascular clinic. The procedure is done to save the rest of the limb or life of the patient.
  • Bypass surgery: For severe cases of PAD with extensive blockages, bypass surgery may be recommended. This involves creating a graft to redirect blood flow around the blocked artery.

The specific treatment for Peripheral Artery Disease (PAD) is individualised based on the severity of the disease, the presence of symptoms, and the overall health of the patient. Management may involve a multidisciplinary team of healthcare professionals, including vascular specialists, cardiologists, and rehabilitation specialists.

Things to remember

  • Usually, procedures will not be needed if vascular consultation is timely.
  • There is not one procedure for all the PAD patients and based on the patient profile, the procedures must be individually planned.
  • The group of patients is extremely disadvantaged with only 50% living beyond 5 years of presentation.
  • The disease can be life-threatening in patients whose arteries of the whole body are narrowing, even though gradually.
  • Proper wound care is essential for individuals with ulcers or non-healing wounds to prevent infections and complications.
  • Supervised exercise programs, often conducted in cardiac rehabilitation settings, can help improve walking distance and overall physical fitness.
  • Individuals with PAD should pay special attention to foot care to prevent complications. This includes inspecting the feet regularly, keeping them clean and moisturised, and wearing comfortable shoes.

How does Peripheral Artery Disease Affect the Body?

  • Muscle ischemia: Decreased blood supply to the muscles can lead to intermittent claudication, causing pain, cramping, or fatigue during physical activity. 
  • Tissue damage: Prolonged insufficient blood flow can result in non-healing wounds, ulcers, and, in severe cases, tissue death (gangrene).
  • Increased cardiovascular risk: PAD is often associated with atherosclerosis, a systemic condition affecting arteries throughout the body. This increases the risk of heart attack and stroke.
  • Compromised quality of life: Symptoms of PAD, such as pain and reduced mobility, can significantly impact an individual's ability to perform daily activities, leading to a reduced quality of life.

What are the Complications of Pad Treatment?

Complications of PAD treatment are relatively rare but may include:

  • Bleeding or hematoma: After procedures such as angioplasty or stent placement, there is a small risk of bleeding or the formation of a hematoma at the puncture site.
  • Infection: Invasive procedures carry a slight risk of infection, particularly if an implanted device, such as a stent, becomes infected.
  • Allergic reactions: Some individuals may experience allergic reactions to contrast dye used in imaging procedures.
  • Restenosis: In some cases, treated arteries may narrow again over time (restenosis), requiring additional intervention.
  • Blood clot formation: Interventional procedures may carry a risk of blood clot formation, which could potentially lead to more serious complications.

It's important to note that these complications are relatively uncommon, and healthcare providers carefully weigh the risks and benefits of interventions based on each patient's specific situation.

How to Reduce the Risk of Peripheral Artery Disease?

To reduce the risk of developing peripheral artery disease, consider the following:

  • Quit smoking: Smoking is a major risk factor for PAD. Quitting smoking is one of the most effective ways to reduce the risk and slow the progression of the disease.
  • Manage chronic conditions: Control conditions such as diabetes, hypertension, and high cholesterol through medication, lifestyle changes, and regular medical check-ups.
  • Adopt a healthy lifestyle: Maintain a balanced diet rich in fruits, vegetables, whole grains, and lean proteins. Engage in regular physical activity and maintain a healthy weight.
  • Regular exercise: Engage in regular physical activity, such as walking, to improve circulation and overall cardiovascular health.
  • Foot care: Individuals with PAD should pay attention to foot care, inspecting their feet regularly and seeking prompt attention for any wounds or infections.
  • Regular check-ups: Schedule regular check-ups with healthcare providers, especially if there are risk factors for PAD, to monitor and manage overall vascular health.

By incorporating these lifestyle changes and preventive measures, individuals can significantly reduce their risk of developing peripheral artery disease and improve their overall cardiovascular health.

Can Peripheral Artery Disease be Reversed?

While peripheral artery disease cannot be completely reversed, its progression can be slowed, and symptoms can be effectively managed. Treatment focuses on improving blood flow, relieving symptoms, and reducing the risk of complications. Lifestyle modifications, medications, and interventional procedures can play a crucial role in controlling the disease. 

Final words

Peripheral artery disease is a serious vascular condition that requires prompt attention and comprehensive management to enhance both the quality of life and overall cardiovascular health. From understanding the risk factors and recognizing early symptoms to adopting a heart-healthy lifestyle and exploring various treatment options, proactive measures can make a significant difference. If you or a loved one is experiencing symptoms or has concerns about peripheral artery disease, waste no time in seeking specialised care from the vascular specialists at Max Hospitals. Equipped with advanced knowledge and technologies, our team is ideally positioned to provide accurate diagnoses and tailored treatment plans for individuals with PAD. Don't let PAD limit your life—consulting a vascular doctor at Max Hospitals, one of India’s leading hospitals for PAD treatment. Your health is our top priority.

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