Conditions

Peripheral Artery Disease

The circulatory system delivers oxygen and nutrients to every part of the body

Peripheral artery disease occurs when atherosclerotic plaque narrows the arteries supplying the legs and feet, progressively reducing blood flow to the lower limbs. PAD is not only a cause of significant limb symptoms — it is a systemic marker of generalised atherosclerosis, associated with a two- to threefold increased risk of myocardial infarction and stroke. Early diagnosis and vascular risk factor management are essential to prevent limb loss and cardiovascular events.

Symptoms

The hallmark symptom of PAD is intermittent claudication — reproducible calf, thigh, or buttock pain triggered by walking and relieved within minutes of rest, caused by insufficient arterial perfusion during exertion. As disease progresses, rest pain develops — a constant burning or aching in the foot that worsens at night. Critical limb ischaemia (CLI), the most advanced stage, presents with non-healing ulcers, gangrene, and severe rest pain, representing a limb-threatening emergency requiring urgent revascularisation. Additional features include cold or pale feet, absent pedal pulses, shiny atrophic skin, and erectile dysfunction in men.

Causes & Risk Factors

PAD shares the same risk factor profile as coronary artery disease: smoking, diabetes mellitus, hypertension, hyperlipidaemia, obesity, and advancing age. Smoking is the single most potent modifiable risk factor — smokers have a fourfold increased PAD risk and significantly worse outcomes after intervention. Diabetes accelerates arterial calcification and is strongly associated with infrapopliteal (below-knee) disease, which carries the highest amputation risk.

Diagnosis

The ankle-brachial index (ABI) is the primary non-invasive diagnostic test — comparing systolic blood pressure at the ankle to the arm. An ABI below 0.9 confirms PAD; values below 0.4 indicate severe disease. Duplex arterial ultrasound maps the location and severity of stenoses without radiation exposure. CT angiography or MR angiography provides detailed roadmapping of the arterial tree prior to intervention. In patients with heavily calcified vessels — particularly diabetics — toe-brachial index (TBI) offers a more reliable pressure measurement.

Treatment

All PAD patients require aggressive cardiovascular risk factor modification — antiplatelet therapy, high-intensity statin treatment, blood pressure control, smoking cessation, and glycaemic optimisation. Supervised exercise therapy is the most evidence-based intervention for intermittent claudication, improving walking distance and functional outcomes. For patients with lifestyle-limiting claudication or critical limb ischaemia, revascularisation is indicated. Endovascular options — balloon angioplasty, stenting, and atherectomy — restore arterial flow through minimally invasive catheter-based techniques with rapid recovery. Surgical bypass grafting remains the preferred approach for complex multi-level disease or where endovascular options are anatomically unsuitable.

Critical Limb Ischaemia — When PAD Becomes a Limb Emergency

Critical limb ischaemia requires urgent specialist assessment and rapid revascularisation to prevent major amputation. A multidisciplinary approach combining vascular intervention, wound care, and infection management is essential. Outcomes are significantly better when patients are referred early — before tissue loss becomes irreversible.

PAD as a Cardiovascular Risk Marker

Patients with confirmed PAD have a significantly elevated risk of myocardial infarction, stroke, and cardiovascular death — even in the absence of cardiac symptoms. Comprehensive cardiovascular assessment, including coronary artery disease screening, is an integral part of PAD management and is routinely performed at our clinic.

Experiencing leg pain on walking, cold feet, or a non-healing wound? Dr. Peter Chang consults at Paragon Medical Centre, Orchard Road. Book a vascular assessment today.