Understanding Peripheral Artery Disease
Peripheral artery disease (PAD) is a common circulatory condition in which narrowed arteries reduce blood flow to the extremities, most often the legs. PAD is caused by atherosclerosis—the buildup of fatty deposits (plaque) inside the arterial walls—and affects an estimated 8.5 million Americans over the age of 40. Despite its prevalence, PAD remains underdiagnosed because many patients attribute their symptoms to normal aging or other causes.
PAD is more than just a leg problem. It is a marker of systemic atherosclerotic disease, meaning patients with PAD are also at significantly increased risk for heart attack and stroke. In its most severe form—known as critical limb ischemia (CLI)—PAD can cause rest pain, non-healing ulcers, gangrene, cardiovascular disease and may ultimately require amputation if blood flow is not restored.
At Vascular Surgical Associates, our board certified Vascular Surgeons have treated thousands of patients with PAD across metro Atlanta since 1986. We offer a full spectrum of care, from conservative management and supervised exercise programs to advanced endovascular interventions and surgical bypass. Our ICAVL-accredited vascular laboratory provides the precise diagnostic testing needed to assess disease severity and guide individualized treatment plans.
Signs & Symptoms
PAD symptoms range from mild discomfort during physical activity to severe pain at rest. Many patients with mild to moderate PAD have no symptoms at all, making routine screening important for individuals with risk factors. When symptoms do develop, they tend to worsen gradually over time without treatment.
Claudication (Leg Pain When Walking)
Cramping, aching, or heaviness in the calf, thigh, or buttock muscles that occurs during walking or exercise and resolves within minutes of rest. This is the most characteristic symptom of PAD.
Numbness or Weakness in Legs
Reduced sensation or a feeling of weakness in the lower extremities, which may be constant or occur during periods of physical activity.
Coldness in Lower Leg or Foot
One leg or foot feeling noticeably cooler than the other, especially when compared side by side, indicating reduced blood flow to that extremity.
Non-Healing Wounds or Sores
Ulcers on the toes, feet, or legs that are slow to heal or fail to heal entirely. This is a sign of advanced PAD (critical limb ischemia) and requires urgent vascular evaluation.
Hair Loss on Legs
Reduced hair growth on the legs and feet is a subtle but telling sign of diminished blood flow to the skin and underlying tissues.
Shiny Skin on Legs
The skin on the legs may appear shiny, smooth, and taut due to chronic poor circulation and changes in the underlying tissue.
Weak or Absent Pulse in Legs
A diminished or absent pulse at the ankle or foot, detectable during a physical exam, is a key clinical indicator of significant arterial blockage in the leg.
Risk Factors
PAD shares the same risk factors as other atherosclerotic diseases, including coronary artery disease and stroke. Many of these risk factors can be modified through lifestyle changes and medical management, making prevention and early intervention possible.
Smoking
Smoking is the strongest risk factor for PAD, increasing the risk by 2 to 6 times. Tobacco use damages the arterial lining and dramatically accelerates plaque formation. Quitting smoking is the single most important step a patient can take.
Diabetes
Diabetes significantly increases PAD risk and is associated with more severe disease, particularly affecting the arteries below the knee. Diabetic patients with PAD face a substantially higher risk of amputation.
High Blood Pressure
Hypertension damages the arterial walls and promotes the progression of atherosclerosis in the peripheral arteries and throughout the cardiovascular system.
High Cholesterol
Elevated LDL cholesterol levels contribute to plaque formation within the arteries. Statin therapy has been shown to slow PAD progression and reduce cardiovascular events.
Age 50 and Older
The prevalence of PAD increases sharply with age, affecting approximately 12–20% of Americans over age 60. Age-related arterial stiffening and cumulative plaque buildup contribute to this increased risk.
Obesity
Excess body weight contributes to insulin resistance, inflammation, and metabolic dysfunction that accelerate atherosclerosis throughout the body, including the peripheral arteries.
Family History & Sedentary Lifestyle
A family history of PAD, heart disease, or stroke increases your risk. Physical inactivity compounds this risk by failing to promote healthy blood flow and cardiovascular fitness.
Diagnosis
Accurate diagnosis of PAD is essential for determining disease severity and selecting the most appropriate treatment strategy. At Vascular Surgical Associates, our ICAVL-accredited vascular laboratory offers a full range of noninvasive and advanced imaging studies to evaluate peripheral arterial circulation.
Ankle-Brachial Index (ABI) is the primary screening test for PAD. This simple, painless test compares the blood pressure measured at the ankle with the blood pressure in the arm. An ABI value of less than 0.90 is diagnostic of PAD, with lower values indicating more severe disease. ABI testing is quick, reliable, and can be performed during an office visit.
Duplex Ultrasound combines traditional ultrasound imaging with Doppler flow analysis to visualize the arteries and assess blood flow in real time. This noninvasive study identifies the location and severity of arterial blockages and is essential for treatment planning. Our credentialed vascular technologists perform comprehensive lower-extremity arterial duplex examinations in our accredited lab.
CT Angiography (CTA) provides detailed three-dimensional images of the entire arterial tree, from the aorta to the foot. CTA is particularly valuable for planning endovascular or surgical revascularization procedures, as it maps the precise anatomy of the blockages and the condition of the arteries above and below.
Angiography is a catheter-based imaging study that provides the most detailed view of the peripheral arteries. It is often performed at the time of endovascular intervention, allowing the vascular surgeon to simultaneously diagnose and treat blockages in a single procedure.
Treatment Options
PAD treatment focuses on relieving symptoms, improving walking distance and quality of life, healing wounds and limb loss. Our vascular surgeons develop individualized treatment plans based on disease severity, symptom burden, and each patient’s goals and overall health.
Supervised Exercise Therapy
A structured, supervised walking program is one of the most effective treatments for claudication. Patients walk under clinical supervision, gradually increasing distance and intensity over 12 weeks. Studies demonstrate that supervised exercise therapy can improve walking distance by 50–200% and is recommended as first-line treatment for PAD-related claudication.
Medication Management
Medical therapy for PAD includes statins to lower cholesterol and stabilize plaques, antiplatelet medications (aspirin, clopidogrel) to reduce the risk of blood clots, and cilostazol to improve walking distance in patients with claudication. Blood pressure and blood sugar control are also critical components of optimal medical management.
Angioplasty and Stenting
This minimally invasive endovascular procedure uses a balloon-tipped catheter to open blocked arteries from the inside. A stent—a small metal scaffold—may be placed to hold the artery open. Angioplasty and stenting is performed through a small puncture, requires minimal recovery time, and is highly effective for focal blockages in the iliac, femoral, and popliteal arteries.
Atherectomy
Atherectomy uses specialized catheter-based devices to physically remove plaque from inside the artery. Various atherectomy technologies—including directional, orbital, and laser atherectomy—allow our surgeons to debulk heavily calcified or complex lesions, often in combination with angioplasty for optimal results.
Bypass Surgery
For patients with extensive or multi-level arterial blockages, surgical bypass reroutes blood flow around the diseased segment using a graft. Bypass surgery provides the most durable long-term results for severe PAD and critical limb ischemia. The saphenous vein is the preferred conduit for below-knee bypass, while synthetic grafts are used for above-knee reconstructions.
Wound Care
For patients with PAD-related non-healing wounds or ulcers, our Wound 360 program provides comprehensive wound management alongside revascularization procedures. Restoring blood flow to the affected limb is essential for wound healing, and our team coordinates vascular intervention with advanced wound care techniques to achieve limb salvage.
Frequently Asked Questions
PAD is very common, affecting an estimated 8.5 million Americans aged 40 and older. The prevalence increases with age, with approximately 12–20% of adults over 60 affected. Despite its prevalence, PAD is frequently underdiagnosed because many patients do not report their symptoms or attribute leg pain to normal aging. If you have risk factors such as smoking, diabetes, or high blood pressure, ask your doctor about PAD screening.
The ankle-brachial index is a simple, noninvasive test that compares the blood pressure at your ankle with the blood pressure in your arm. Using blood pressure cuffs and a Doppler ultrasound device, the test takes about 10–15 minutes and is painless. A normal ABI is between 1.0 and 1.4. An ABI below 0.90 indicates the presence of PAD, with lower values indicating more severe arterial narrowing. This test is available at all of our office locations.
In severe cases, PAD can progress to critical limb ischemia (CLI), where blood flow is so reduced that it causes rest pain, non-healing ulcers, or gangrene. Without treatment, CLI can lead to amputation. However, with early diagnosis and appropriate treatment—including endovascular interventions, bypass surgery, and comprehensive wound care—many amputations can be prevented. This is why seeking care from experienced vascular surgeons at the first sign of PAD symptoms is so important.
Yes. PAD is a strong indicator that atherosclerosis is present throughout your cardiovascular system. Patients with PAD have a 4–5 times higher risk of heart attack and 2–3 times higher risk of stroke compared to those without PAD. This is why treatment of PAD includes not only addressing the leg symptoms but also aggressive management of cardiovascular risk factors such as cholesterol, blood pressure, diabetes, and smoking cessation.
