What is PAD?
Peripheral arterial disease most commonly results from atherosclerotic plaque accumulating in the arteries of the pelvis and legs. Mild disease may limit blood flow only during exercise; advanced disease can impair perfusion even at rest and threaten tissue viability.
Symptoms and clinical spectrum
Chronic symptoms
- Calf, thigh, or buttock discomfort with walking
- Reduced walking distance
- Leg fatigue or weakness
- Coldness or color change
Advanced disease
- Rest pain
- Nonhealing wounds
- Gangrene or tissue loss
- Acute sudden limb ischemia
How PAD is diagnosed
Evaluation begins with history, pulse examination, skin and foot assessment, and often an ankle-brachial index (ABI). Duplex ultrasound, CT angiography, MR angiography, or catheter angiography may be used when anatomy needs further definition or intervention is being considered.
PAD treatment is more than opening an artery
Modern PAD care includes aggressive cardiovascular risk reduction. The 2024 ACC/AHA guideline emphasizes antiplatelet or antithrombotic therapy when appropriate, high-intensity lipid lowering, blood-pressure control, diabetes management, smoking cessation, structured exercise, preventive foot care, and revascularization when clinically indicated.
When revascularization is considered
Revascularization can be used to improve walking and quality of life in patients with functionally limiting claudication that persists despite guideline-directed medical therapy and structured exercise. In chronic limb-threatening ischemia, revascularization is used to help prevent tissue loss and amputation whenever anatomically and clinically feasible.
Endovascular options
Depending on anatomy, lesion length, calcification, location, and clinical goals, catheter-based treatment may involve balloon angioplasty, drug-coated technology, stent placement, atherectomy, thrombectomy, or other specialized techniques. Some disease patterns are better suited to bypass surgery or a hybrid approach.
Why multidisciplinary care matters
PAD frequently coexists with coronary, carotid, renal, and diabetic vascular disease. Patients with ulcers or limb-threatening ischemia often benefit from coordinated vascular, wound-care, podiatric, infectious-disease, endocrine, and surgical expertise.
Procedure Video
See angioplasty and stenting for PAD
Educational PAD angioplasty and stenting video. Third-party educational video; technique and equipment vary.