Peripheral Artery Disease (PAD): Symptoms, Causes, and Treatment

What is peripheral artery disease?

Peripheral artery disease (PAD) is the buildup of fatty plaque inside the arteries that carry blood to your limbs — most often your legs. As the plaque thickens, it narrows the artery and limits blood flow, the same process that causes heart disease, but in the legs instead of the heart. Because the heart and legs share the same arteries' worth of risk, PAD is also a warning sign for cardiovascular trouble elsewhere in the body.

The 2024 national PAD guidelines from the Society for Vascular Surgery, the American Heart Association and the American College of Cardiology describe four stages of the disease:

• Asymptomatic PAD — narrowing is present, but you may not notice symptoms yet, even though walking ability can already be affected.
• Chronic symptomatic PAD — including claudication, the leg pain or cramping that comes on with walking and eases with rest.
• Chronic limb-threatening ischemia (CLTI) — the most advanced stage, with rest pain, non-healing wounds, or tissue loss that puts the limb at risk.
• Acute limb ischemia — a sudden loss of blood flow that is a medical emergency.

What are the symptoms of PAD?

The most common symptom of PAD is leg pain, cramping, or fatigue that appears when you walk and goes away when you stop. Many people assume this is just aging or arthritis, which is one reason PAD goes undiagnosed for so long.

Warning signs to take seriously:

• Cramping, aching, or heaviness in the calf, thigh, or buttock when walking
• Leg pain at rest, especially at night or when lying flat
• Sores or wounds on the feet or toes that heal slowly or not at all
• Skin on the legs or feet that is cool, pale, shiny, or bluish
• Hair loss on the legs, slow-growing toenails, or weak pulses in the feet
• Numbness or weakness in the legs

What causes PAD, and who is at risk?

PAD is caused by atherosclerosis — the same plaque buildup behind most heart attacks and strokes. Your risk is higher if you:

• Smoke now or smoked in the past
• Have diabetes
• Have high blood pressure or high cholesterol
• Are over 65, or over 50 with other risk factors
• Have kidney disease
• Have a personal or family history of heart disease, stroke, or vascular disease

Diabetes and kidney disease deserve special attention. Both sharply increase the risk of PAD and its most serious complications, including foot wounds and limb loss, which is why people managing these conditions benefit from having a vascular specialist involved early.

How is PAD diagnosed?

PAD is most often diagnosed with a simple, painless test called the ankle-brachial index (ABI), which compares the blood pressure in your ankle to the blood pressure in your arm. A lower reading in the ankle signals reduced blood flow. The national guidelines name the ABI, combined with a careful history and physical exam, as the primary way to detect PAD in most patients.

When more detail is needed, we use non-invasive vascular ultrasound and, in select cases, advanced imaging to map exactly where the arteries are narrowed and plan the right treatment.

How is PAD treated?

PAD treatment starts with the least invasive, most evidence-based steps and escalates only when needed. For most people, the foundation is risk-factor control and movement — not surgery.

Foundational care for every patient:

• Stopping tobacco — the single most important step to slow PAD.
• Medications that protect the heart and limbs, including high-intensity statins and, for appropriate patients, a low-dose blood-thinning regimen shown in the 2024 guidelines to reduce both cardiovascular and limb events.
• Managing blood pressure, cholesterol, and diabetes.
• Structured exercise therapy — a supervised walking program is one of the most effective treatments for claudication and is now covered by Medicare and many commercial plans.

Procedures to restore blood flow (revascularization):

When symptoms limit your life despite medical therapy and exercise, or when the limb itself is threatened, we restore blood flow through minimally invasive or surgical procedures, including:

• Angioplasty and stenting — opening the narrowed artery from the inside through a small puncture.
• Atherectomy — removing plaque from within the artery.
• Bypass surgery — rerouting blood flow around a blocked segment when that is the better option.

As a board-certified vascular surgeon trained in both open surgical and minimally invasive endovascular techniques, Dr. Cardentey can offer the full range of these options and match the approach to your anatomy, rather than being limited to a single tool.

When should I see a vascular specialist for PAD?

You should see a vascular specialist if you have leg pain with walking, a non-healing foot wound, or risk factors like diabetes or a history of smoking — especially before accepting any recommendation for amputation. A vascular evaluation can determine whether blood flow can be restored, and in many cases it can be.

This matters more than most people realize. A vascular surgeon's job is to find a way to keep blood flowing to the limb. If you've been told an amputation may be necessary, a vascular opinion first is one of the most important steps you can take.