Peripheral arterial disease (PAD) is caused by the build-up of atherosclerotic plaques in the arteries supplying the legs, progressively narrowing or blocking them and reducing blood flow. It affects an estimated 200 million people worldwide and is a strong predictor of cardiovascular events including heart attack and stroke.

Stages of PAD (Fontaine Classification)

  • Stage I: Asymptomatic — atherosclerosis present but no symptoms
  • Stage II: Intermittent claudication — cramping leg pain on walking, relieved by rest
  • Stage III: Rest pain — constant foot pain, worse at night
  • Stage IV: Critical limb ischemia — ulcers, gangrene, threatened limb loss

Risk Factors

  • Smoking (the single most important modifiable risk factor)
  • Diabetes mellitus
  • Hypertension
  • High cholesterol
  • Age over 65 years
  • Family history of cardiovascular disease

⚠️ Don't Dismiss Leg Pain as "Just Getting Old"

Claudication — leg cramping that comes on after walking a predictable distance and is relieved by rest — is a classic symptom of PAD. It is not normal ageing and should be investigated promptly.

Diagnostic Workup

  • Ankle-Brachial Index (ABI): Simple, non-invasive first test — ABI <0.9 confirms PAD
  • Arterial Duplex Ultrasound: Identifies location and severity of stenoses/occlusions
  • CT Angiography (CTA): Detailed 3D mapping of all infrarenal arteries for surgical planning
  • Digital Subtraction Angiography (DSA): Gold standard, combined with immediate endovascular treatment

Treatment Options

1. Medical Management (all stages): Antiplatelet therapy, statins, ACE inhibitors, smoking cessation, structured walking exercise programme.

2. Endovascular (Catheter-Based) Treatment:

  • Percutaneous Transluminal Angioplasty (PTA) — balloon dilation of stenotic arteries
  • Stenting — metal stent to maintain lumen patency
  • Atherectomy — plaque removal devices for heavily calcified lesions

3. Open Bypass Surgery:

  • Aorto-bifemoral bypass for aortoiliac disease
  • Femoro-popliteal or femoro-tibial bypass for infrainguinal disease using vein or synthetic graft

✅ Results of Endovascular Treatment

For femoropopliteal PAD, balloon angioplasty and stenting achieve 70–85% primary patency at one year for suitable lesions, with immediate symptom relief. Hybrid procedures combining catheter and surgical techniques are increasingly used for complex multilevel disease.

Experiencing Leg Pain on Walking?

Book a vascular assessment with Dr. Mohamed Haggag — early diagnosis and treatment prevents progression to critical limb ischemia

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