Arterial Conditions
Peripheral Arterial Disease
Specialist assessment and treatment for reduced blood flow to the legs, from walking-related symptoms through to complex limb-threatening arterial disease.
Understanding PAD
What is peripheral arterial disease?
Peripheral arterial disease, often shortened to PAD, occurs when the arteries supplying the legs become narrowed or blocked, reducing the amount of blood reaching the muscles and tissues.
The most common underlying cause is atherosclerosis, where fatty deposits build up within the arterial wall.
Some people have few or no symptoms, while others develop pain when walking. More advanced disease can cause pain at rest, non-healing wounds or tissue damage because the foot is not receiving enough blood.
Common signs and symptoms
- Calf, thigh or buttock pain when walking
- Symptoms that improve after resting
- Reduced walking distance
- Coldness or numbness in the foot
- Pain in the foot at rest, particularly at night
- Ulcers or wounds that do not heal
- Changes in the colour or condition of the toes or foot
Symptoms
PAD can range from mild symptoms to severe circulation problems
Symptoms depend on how much blood flow is restricted and which arteries are affected.
Intermittent Claudication
Aching, cramping or discomfort in the leg during walking that settles after a period of rest.
Reduced Walking Distance
Some patients find they can walk progressively shorter distances before needing to stop because of discomfort.
Rest Pain
Severe arterial disease can cause persistent pain in the foot even when you are not walking.
Cold or Numb Feet
Reduced circulation may make one foot feel colder or cause altered sensation in the toes or foot.
Non-Healing Wounds
Poor circulation can prevent ulcers, cuts or other wounds from healing normally.
Tissue Loss
Severe restriction of blood flow may cause ulceration or tissue damage and requires specialist vascular assessment.
PAD is part of a wider cardiovascular condition
Atherosclerosis can affect arteries throughout the body, not only those supplying the legs. This means PAD is also an important marker of cardiovascular risk.
Causes & Risk Factors
Why does peripheral arterial disease develop?
PAD is most commonly caused by atherosclerosis. Several factors increase the risk of developing narrowing within the arteries.
Diagnosis
Assessing blood flow to the legs
The first step is to understand the pattern of your symptoms and assess the circulation in the legs and feet.
Depending on your findings, further testing may be used to confirm arterial disease and determine the location and severity of any narrowing.
Clinical Assessment
Review of symptoms, walking limitation, medical history and examination of the legs and arterial pulses.
ABPI
An ankle-brachial pressure index compares blood pressure at the ankle with blood pressure in the arm.
Vascular Imaging
Duplex ultrasound and, when required, CT or MR angiography can provide more detailed information before treatment.
Whole-Patient Care
Treating PAD means looking beyond the arteries in the leg
Peripheral arterial disease is associated with an increased risk of cardiovascular problems elsewhere in the body.
Management therefore includes not only improving leg symptoms and circulation, but also identifying and addressing wider cardiovascular risk factors.
Management may include attention to
- Smoking cessation
- Cholesterol management
- Blood pressure control
- Diabetes management
- Regular physical activity
- Appropriate cardiovascular medication following clinical assessment
Initial Management
Not everyone with PAD needs an operation
Treatment depends on your symptoms, overall health and the severity of the arterial disease.
Exercise
Structured or supervised exercise can improve walking ability and is an important part of managing intermittent claudication.
Risk-Factor Management
Smoking, cholesterol, blood pressure, diabetes and other cardiovascular risk factors should be addressed.
Medication
Medication may be recommended to reduce cardiovascular risk and, in selected patients, help manage symptoms of PAD.
Restoring Blood Flow
Endovascular and surgical treatment
When symptoms are severe, quality of life is significantly affected or the limb is threatened, a procedure to improve blood flow may be appropriate.
Angioplasty & Stenting
Angioplasty uses a small balloon introduced through an artery to open a narrowed or blocked section. A stent may sometimes be used to help keep the treated artery open.
Bypass Surgery
Bypass surgery creates a new route for blood to travel around an area of severe arterial narrowing or blockage, using a vein or other graft material.
Lower-limb revascularisation and limb preservation
Mr Benaragama has specialist fellowship experience in lower-limb salvage and complex revascularisation, including patients with severe arterial disease, diabetic foot problems and limb-threatening circulation.
Advanced PAD
When circulation becomes limb-threatening
Severe PAD can reduce blood flow to the foot to the point where wounds fail to heal, pain occurs at rest or tissue begins to deteriorate.
In these situations, rapid specialist assessment is important. Treatment may require endovascular intervention, bypass surgery or a combination of vascular and wound-care strategies.
The priority is to assess whether circulation can be improved and, wherever possible, preserve a functional limb.
Urgent Circulation Problems
Sudden or severe symptoms need urgent medical assessment
Seek urgent medical attention if a leg or foot suddenly becomes severely painful, cold, pale or numb, or if you develop rapidly worsening tissue damage. Do not wait for a routine private appointment.
Persistent pain in the foot at rest, non-healing ulcers or blackening of a toe also require prompt clinical assessment.
Frequently Asked Questions
Peripheral arterial disease questions
Is leg pain when walking always caused by PAD?
No. Several conditions can cause leg pain when walking, including problems involving the spine, joints, muscles or veins. A vascular assessment can help determine whether reduced arterial blood flow is contributing to your symptoms.
What is intermittent claudication?
Intermittent claudication is discomfort in the leg caused by insufficient blood flow during exercise. It commonly appears after walking a certain distance and improves after resting.
Does everyone with PAD need angioplasty?
No. Many people are initially managed with exercise, cardiovascular risk-factor management and medication. Intervention is considered according to symptom severity, arterial anatomy and individual circumstances.
What is an ABPI test?
An ankle-brachial pressure index compares the blood pressure measured at the ankle with the blood pressure in the arm. It helps assess whether circulation to the leg may be reduced.
What is the difference between angioplasty and bypass?
Angioplasty is a minimally invasive procedure performed from inside the artery, whereas bypass surgery creates a new route for blood to travel around a blocked artery. The most appropriate option depends on the pattern of disease and the patient.
Can PAD affect more than my legs?
PAD is usually caused by atherosclerosis, which can also affect arteries elsewhere in the body. This is why cardiovascular risk reduction is an important part of PAD treatment.
Peripheral Arterial Disease Consultation
Request a specialist vascular consultation
If you are experiencing walking-related leg pain, have been diagnosed with PAD, or would like a specialist opinion about your circulation, please contact the practice by email.
Email to Request a Consultation → benaragama.admin@lips.org.uk