- PAD is atherosclerosis (plaque buildup) narrowing the arteries to the legs and feet.
- Classic symptoms are calf cramping with walking (claudication) that improves with rest.
- Many patients have no symptoms — but PAD still raises risk of poor wound healing and amputation.
- Diabetic patients with PAD are at particularly high risk for limb-threatening foot infection.
- NES coordinates with vascular surgery for diagnosis (ABI, ultrasound) and intervention when needed.
What is peripheral artery disease?
Peripheral Artery Disease (PAD) is narrowing of the arteries supplying the lower extremities due to atherosclerosis — the same plaque-building process that causes coronary artery disease. Reduced blood flow means muscles don't get enough oxygen during activity (claudication) and tissues don't get enough oxygen for normal repair (poor wound healing).
PAD is common — affecting roughly 8 million Americans over 40. Risk factors are the same as for coronary disease: smoking, diabetes, hypertension, high cholesterol, age, and family history. Diabetic patients are at particularly high risk; the combination of diabetes and PAD dramatically increases amputation risk.
At NES, we screen diabetic patients and other high-risk patients for PAD with a simple bedside test: the ankle-brachial index (ABI). Patients with abnormal ABIs or with concerning symptoms are co-managed with our vascular surgery partners for further evaluation and intervention when indicated.
See it in motion
Animations licensed from ViewMedica · Swarm Interactive
What it feels like
PAD has a spectrum of presentations from asymptomatic to limb-threatening:
- Cramping or aching pain in the calf, thigh, or buttock with walking (claudication)
- Pain that improves with rest within a few minutes
- Distance you can walk before pain has shortened over time
- Cold, pale, or blue feet
- Hair loss on the lower legs
- Slow-healing or non-healing wounds on the foot or lower leg
- Foot pain at rest, especially at night (advanced PAD)
- Many patients have NO symptoms despite significant disease — silent PAD is common
Why it develops
PAD shares risk factors with coronary artery disease:
- Smoking (the single most important modifiable risk factor)
- Diabetes mellitus, especially long-standing diabetes
- High blood pressure
- High cholesterol
- Age over 65
- Family history of PAD or other atherosclerotic disease
- Chronic kidney disease
How we diagnose peripheral artery disease
The ankle-brachial index (ABI) — comparing blood pressure at the ankle to blood pressure at the arm — is the first-line screening test. An ABI under 0.9 confirms PAD. Diabetic patients sometimes have falsely elevated ABIs from arterial calcification; toe-brachial index (TBI) is more reliable in those cases. Arterial duplex ultrasound localizes blockages.
Non-surgical care
Most patients with PAD are managed medically. Risk-factor modification is the foundation:
- Smoking cessation — non-negotiable, the single highest-impact intervention
- Optimal diabetes control
- Blood pressure and cholesterol management
- Statin therapy
- Antiplatelet therapy (aspirin, clopidogrel)
- Structured walking program — supervised exercise therapy improves walking distance
- Wound care for any non-healing ulcers
- Diabetic foot care education to prevent ulceration
Surgical care
Vascular intervention is reserved for severe claudication impacting quality of life, rest pain, or non-healing wounds. Procedures are performed by our vascular surgery partners.
- Endovascular intervention — angioplasty with or without stenting
- Atherectomy (plaque removal)
- Bypass grafting for long blockages
- Amputation as a last resort for non-salvageable limbs
Recovery varies dramatically by procedure. Endovascular interventions are often same-day. Bypass grafting requires several days in the hospital and weeks of restricted activity.
When to see a specialist
- Claudication — cramping leg pain with walking that improves with rest
- A wound on the foot or lower leg that's not healing
- Foot pain at rest, especially at night
- New cold, pale, or blue foot
- Any diabetic patient who has not had an ABI screening in 12 months
PAD screening and foot care are led by Dr. Cara Beach (diabetic foot specialist) and Dr. Manny Moy. Vascular surgical evaluation and intervention are coordinated with our vascular surgery partners.