What Is Peripheral Artery Disease (PAD) and How Is It Treated?

Peripheral artery disease (PAD) is a common circulatory condition that occurs when narrowed arteries reduce blood flow to the limbs—most often the legs. This restriction can cause pain, numbness, and mobility issues. If left untreated, PAD may lead to serious complications such as infections or even limb loss.

Fortunately, PAD is both preventable and manageable with the right combination of lifestyle changes, medications, and in some cases, minimally invasive procedures. In this article, Dr. Hussain, vascular and endovascular surgeon at Riverside Healthcare, discusses what causes PAD, how it’s diagnosed, and the most effective treatment options available to improve circulation and quality of life.

The New Definition of PAD

Peripheral artery disease was originally defined as any atherosclerotic (plaque buildup) or thrombotic (clotting) condition affecting arteries outside the heart or brain. This includes arteries in areas like the neck, chest, abdomen, pelvis, arms, and legs. That’s changed in recent years.

“What we focus mostly on with peripheral artery disease now is as a disease that affects the legs, which means pretty much from the abdomen down to the toes,” states Dr. Hussain. “That's how PAD is defined today, as atherosclerosis, plaque buildup, clotting disorders of the arteries in the legs.”

Symptoms and Risk Factors of PAD

Symptoms of PAD typically manifest in the lower extremities and are most noticeable during physical activity. Common symptoms include pain, cramping, or a "Charlie horse" sensation in the calves, thighs, or buttocks while walking—relieved by rest. Another sign is foot pain or toe numbness at night that improves when the foot is placed on the floor. These symptoms are key indicators of PAD.

The main risk factors for PAD include a history of diabetes and smoking—especially if someone has smoked more than 100 cigarettes in their lifetime. Other high-risk groups include individuals with kidney disease, particularly those on dialysis or at risk of needing it. Additional risk factors are being over age 55 and male, though PAD can affect both men and women.

“Obviously, an underlying history of heart disease, such as high blood pressure and high cholesterol, are all risk factors for PAD,” explains Dr. Hussain. “But, if you were to ask me what the three top risk factors are, it would be diabetes, smoking, and kidney disease.”

Diagnosing PAD and Initial Treatment Options

One of the simplest and non-invasive ways to diagnose PAD is through an Ankle-Brachial Index (ABI) test and toe pressure measurement. The ABI involves comparing blood pressure in the foot to that in the arm. A low index value indicates reduced blood flow and suggests the presence of PAD.

For patients with PAD symptoms that occur only during activity, the primary treatment is a structured walking program—encouraging them to walk through the pain to improve circulation over time. In addition, managing diabetes with tight blood sugar control, using antiplatelet medications like aspirin or clopidogrel, and maintaining healthy blood pressure and cholesterol levels—often with medication—are essential parts of effective PAD treatment.

“Those things go hand-in-hand. The walking program, aspirin, cholesterol medication, and blood pressure control. Oftentimes, all four of those things controlled together really can keep the patient out of a procedure for a long time,” assures Dr. Hussain.

What If the Conservative Treatment Options Don’t Work?

If symptoms persist despite the above-mentioned efforts, the next step is an angiogram—a catheter-based X-ray that maps the arteries and helps determine whether surgery, stents, or angioplasty is the best course of action.

Dr. Hussain notes that vascular surgery has advanced to include both traditional surgical and minimally invasive options, allowing specialists to tailor treatment plans based on each patient’s needs. He explains that the area where many of the new developments are occurring is in the interventional space, which is always moving at a rapid pace.

“There is so much new technology coming out. We can go in with scopes, go in with atherectomy devices where we shave plaque out of the artery. We have balloons we use to deliver a drug into the artery to minimize it from re-narrowing. The coolest, latest thing is we have stents that we can put in that are bioabsorbable, meaning the stents disappear after ninety days. The stent dissolves, then it's gone. So, the patient doesn't have to walk around with a stent for the rest of their life,” shares Dr. Hussain. “Those are some of the more exciting things coming out.”

For more information on heart and vascular care at Riverside visit riversidehealthcare.org/heart.