Quick answer

What is peripheral arterial disease?

Peripheral arterial disease (PAD) is a condition where arteries in the legs become narrowed or blocked by atherosclerosis, reducing blood flow to the muscles. The main symptom is leg pain when walking that eases with rest (intermittent claudication). PAD is a sign of widespread cardiovascular disease — people with PAD have higher risk of heart attack and stroke. Treatment includes exercise programmes, statins, blood pressure control, stopping smoking, and sometimes surgery or angioplasty.

Peripheral arterial disease — when leg arteries narrow

Peripheral arterial disease (PAD) is narrowing or blockage of arteries — usually in the legs — caused by atherosclerosis, the same fatty plaque build-up that causes heart attack and stroke.

PAD is not just a leg condition. It signals widespread cardiovascular disease and carries a significantly higher risk of heart attack, stroke, and premature death.

Symptoms — leg pain on walking

The classic symptom is intermittent claudication:

  • Cramping, aching, or tiredness in calves, thighs, or buttocks when walking
  • Pain comes on predictably after a certain distance
  • Relieved within minutes of stopping and resting
  • Over time, walking distance may shorten

Other signs:

  • Weak or absent pulses in feet
  • Cold feet compared to the other leg
  • Hair loss on legs and toes
  • Shiny, pale skin on lower legs
  • Slow-healing wounds or ulcers on feet
  • Erectile dysfunction in men

Many people have no symptoms — PAD is found during cardiovascular assessment.

Risk factors

  • Smoking — the strongest modifiable risk factor
  • Diabetes
  • High blood pressure
  • High cholesterol
  • Obesity
  • Age — more common over 50
  • Family history of cardiovascular disease

Diagnosis

  1. Clinical examination — checking leg and foot pulses
  2. Ankle-brachial pressure index (ABPI) — ratio below 0.9 suggests PAD
  3. Duplex ultrasound — shows blood flow and narrowing
  4. CT or MR angiography — detailed artery mapping before intervention
  5. Blood tests — cholesterol, HbA1c, kidney function

Treatment

Cardiovascular risk management — for everyone with PAD

  • Statins — high-intensity such as atorvastatin 80mg
  • Antiplatelet therapy — clopidogrel or aspirin
  • Blood pressure control — target below 140/90 mmHg
  • Diabetes management — HbA1c optimisation
  • Stop smoking — specialist support available on NHS

Exercise therapy

Supervised exercise programmes — walking until pain develops, resting, then continuing — are first-line treatment for claudication and improve walking distance as effectively as some procedures.

Procedures

For severe claudication not responding to exercise, or critical limb ischaemia:

  • Angioplasty and stenting — balloon opens the artery
  • Bypass surgery — graft routes blood around the blockage

Critical limb ischaemia — emergency

Seek urgent same-day assessment for:

  • Leg pain at rest — especially waking you at night
  • Non-healing foot wound or ulcer
  • Gangrene — black discoloured toes or foot
  • Sudden cold, pale, painful leg — acute limb ischaemia

Without prompt treatment, limb loss is a real risk.

PAD and your heart

If you have PAD, treat it as a warning about overall artery health. Attend cardiovascular reviews, take prescribed medicines, and address every risk factor. See angina and heart attack for related coronary artery disease.

Common questions

What is peripheral arterial disease?
PAD is narrowing or blockage of arteries outside the heart — most commonly in the legs — caused by atherosclerosis (build-up of fatty plaques). Reduced blood flow causes leg pain on exertion. It is part of the same disease process that causes heart attack and stroke.
What are the symptoms of PAD?
The hallmark is intermittent claudication — aching, cramping, or tiredness in the calves, thighs, or buttocks when walking, relieved within minutes of resting. Other signs include leg weakness, cold feet, hair loss on legs, shiny skin, slow-healing wounds on feet, and erectile dysfunction in men.
What causes peripheral arterial disease?
Atherosclerosis — the main cause — is driven by smoking, diabetes, high blood pressure, high cholesterol, obesity, and ageing. Smoking is the strongest risk factor. PAD becomes more common after age 50 and affects men and women equally.
How is PAD diagnosed?
A GP examines pulses in the legs and feet. The ankle-brachial pressure index (ABPI) — comparing blood pressure at the ankle and arm — is the key test. Ultrasound or CT angiography maps artery narrowing. Blood tests check cholesterol, glucose, and kidney function.
How is peripheral arterial disease treated?
All patients need cardiovascular risk management — statins, antiplatelets (aspirin or clopidogrel), blood pressure control, and diabetes management. Stop smoking — the single most important step. Supervised exercise therapy improves walking distance. Severe cases may need angioplasty, stenting, or bypass surgery.
Is PAD linked to heart attack and stroke?
Yes. PAD indicates atherosclerosis throughout the body. People with PAD have a significantly higher risk of heart attack, stroke, and death from cardiovascular disease. Managing overall cardiovascular risk is as important as treating leg symptoms.
What is critical limb ischaemia?
The most severe form of PAD — leg pain at rest (especially at night), non-healing wounds, or gangrene. This is a vascular emergency needing urgent specialist assessment — risk of limb loss without prompt treatment.

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