Peripheral Artery Disease — Leg Artery Blockages
Peripheral artery disease (PAD) is atherosclerosis affecting the arteries of the legs — the same disease process that causes coronary artery disease in the heart. Narrowed leg arteries reduce blood flow to the muscles, skin, and nerves, causing pain on walking, non-healing wounds, and in severe cases, limb-threatening ischaemia. PAD is significantly underdiagnosed in India, where high diabetes prevalence makes it more severe and more common than in Western populations.
Symptoms
| Intermittent claudication | Calf, thigh, or buttock pain that comes on reliably after a set walking distance and resolves with rest within minutes. The hallmark of moderate PAD. |
| Rest pain | Persistent pain in the foot and toes even at rest — typically worse at night, relieved by hanging the leg over the bed. Indicates severe ischaemia requiring urgent intervention. |
| Non-healing ulcers | Wounds on the foot or toes that do not heal — often at pressure points or after minor trauma. A sign of critical limb-threatening ischaemia (CLTI). |
| Gangrene | Blackening and death of tissue — from complete loss of blood supply. Urgent revascularisation is the only alternative to amputation. |
| Absent foot pulses | Reduced or absent pulses in the foot on examination — a clinical sign of significant PAD. |
PAD and cardiac risk
PAD is a marker of systemic atherosclerosis. Patients with PAD have 3 to 4 times higher risk of heart attack and stroke. All patients with PAD require a comprehensive cardiovascular assessment — including echocardiogram and coronary angiogram evaluation when indicated.
Diagnosis
- Ankle-brachial index (ABI) — first-line test. ABI below 0.9 confirms peripheral arterial disease (PAD). ABI below 0.4 indicates critical limb ischaemia.
- Arterial duplex ultrasound — maps the arterial tree, identifies blockage location and severity.
- CT angiography — detailed 3D vascular mapping essential for planning endovascular or surgical intervention.
Treatment
- Medical therapy — aspirin, statin (LDL below 55 mg/dL), blood pressure control, smoking cessation, diabetes optimisation. Essential for all patients.
- Supervised exercise programme — the most effective treatment for claudication. 30 to 45 minutes of walking to mild–moderate pain, 3 times per week, for 3 months.
- Peripheral angioplasty and stenting — catheter-based opening of blocked leg arteries. Drug-coated balloons for femoral disease. Tibial angioplasty for critical limb ischaemia. Performed by :contentReference[oaicite:0]{index=0} at :contentReference[oaicite:1]{index=1}.
- Bypass surgery — for extensive disease not suitable for endovascular treatment.