Peripheral Artery Disease Treatment in Delhi, India

Peripheral Artery Disease (PAD) occurs when the arteries that supply blood to the limbs, usually the legs, become narrowed or blocked due to atherosclerosis. If left untreated, PAD can cause critical limb ischemia or a heart attack/stroke.

The progressive systemic disease can be caused by atherosclerosis, underlying health conditions and lifestyle choices. An understanding of PAD causes can help prevent and manage the disease.

Atherosclerosis

The most common cause of PAD, atherosclerosis occurs when fatty deposits (plaque) accumulate in the walls of arteries, causing them to harden and narrow. If atherosclerosis goes untreated for a long time, it can cause potentially life threatening complications. 

Inflammatory Conditions 

Rheumatoid arthritis, lupus, inflammatory bowel disease, and other inflammatory conditions can lead to the release of pro-inflammatory cytokines such as TNF-α, IL-6, and CRP (C-reactive protein). These molecules cause endothelial dysfunction, which leads to a buildup of plaque in the inner lining of arteries. 

Blood Clotting Disorders

Factor V Leiden mutation, antiphospholipid syndrome (APS) and other blood clotting disorders can cause hypercoagulability, leading to the formation of blood clots. Left untreated, blood clots can partially or completely block arteries, leading to ischemia (lack of oxygen) in the legs and feet.

Hyperhomocysteinemia

Homocysteine is a naturally occurring amino acid in the body that is produced during the metabolism of methionine. Increased homocysteine levels damage endothelial cells (the inner lining of blood vessels), affecting their ability to produce nitric oxide (NO), a potent vasodilator. Decreased production of nitric acid leads to narrowing of blood vessels. 

Diabetes 

High blood sugar (hyperglycemia) damages the endothelium (a single layer of cells that line blood vessels). This leads to inflammation, which causes arteries to narrow. Diabetes increases low-density lipoprotein (LDL, "bad" cholesterol) and reduces high-density lipoprotein (HDL, "good" cholesterol) levels, causing fat to build up in arteries. An abnormal fat buildup in arteries can restrict blood flow.

Several factors increase the risk of developing PAD, ranging from ageing to family history of the condition. 

Age

Ageing is associated with chronic low-grade inflammation, which damages blood vessels and leads to plaque formation. The body’s ability to repair and regenerate damaged blood vessels declines with age. No wonder PAD is more common in elderly adults (affects 12-20% of people over 60). 

Family History 

Some inherited health conditions (such as diabetes and hypertension) cause inflammation or clots to form. Inflammation and blood clots can increase one’s risk of PAD by narrowing arteries or affecting blood flow. In individuals with a family history of PAD, the condition may develop at a younger age.

Gender 

Men are at a higher risk of developing PAD than women, as higher testosterone levels in men may lead to arterial stiffness, causing atherosclerosis. In premenopausal women, estrogen, the female sex hormone, helps reduce inflammation, lowering their risk of PAD.

An Unhealthy Lifestyle 

A sedentary lifestyle can lead to obesity, which can cause diabetes and hypertension. Both diabetes and high blood pressure increases an individual’s risk of PAD. An unhealthy diet high in saturated fats, trans fats, and refined sugars can lead to atherosclerosis-the most common cause of PAD and high LDL (bad cholesterol) levels, which can contribute to arterial damage.

Chronic Kidney Disease 

The inner lining of blood vessels (the endothelium) helps regulate blood flow and prevent clot formation. In people with CKD, uremic toxins and chronic inflammation can affect endothelial function, causing blood vessels to narrow. CKD can lead to dyslipidemia (abnormal cholesterol levels), a risk factor for atherosclerosis.

PAD often develops gradually, with symptoms ranging from mild discomfort to severe pain that can impact mobility affecting a person’s quality of life. 

Claudication (Pain or Cramping in Legs)

PAD is usually caused by atherosclerosis, a condition characterised by narrowing and stiffening of arteries. Narrowed arteries fail to supply enough oxygen to the legs (especially during exercise), leading to painful leg cramps. In severe cases, pain may persist even when the person lies down to rest.

Sores or Wounds That Don’t Heal

The chronic progressive atherosclerotic disease can lead to poor circulation, which slows down the wound healing process. This leads to the formation of non-healing foot, toe, and leg ulcers. Over time, non healing sores or wounds can become infected, leading to gangrene (tissue death).

No Pulse or a Weak Pulse in the Legs or Feet

When the arteries supplying blood to the legs become narrow due to plaque buildup, less oxygen-rich blood reaches the lower extremities. Decreased blood flow leads to increased arterial pressure, causing no pulse or a weak pulse in the legs. 

Skin Discolouration 

A buildup of plaque in arteries results in reduced blood flow, which can cause the skin on the legs or feet to appear pale or whitish, especially when the affected limb is elevated. Long-term poor circulation leads to permanent changes in skin texture and appearance, making it look shiny and thin.

Cold Feet

Atherosclerosis prevents warm, oxygen-rich blood from reaching the feet, making one’s feet cold. Cold feet caused by peripheral artery disease (PAD) indicates poor circulation (which can lead to serious complications) and can be a cause for concern.

Physicians perform clinical evaluations and use non-invasive tests to assess blood flow and check if their patients’ arteries have become clogged. 

Clinical Evaluation

Doctors assess their patients’ symptoms and PAD risk factors to diagnose the condition. They also perform a physical examination which involves checking their patients’ pulse, looking at their skin, and checking sores or wounds.

• A weak or absent pulse in the legs or feet can indicate an artery blockage
• Cool, pale, or shiny skin and hair loss on legs may indicate poor blood flow
• Slow or non-healing sores/wounds can be a symptom of PAD 

Ankle-Brachial Index Test

ABI is a simple, non-invasive test that involves measuring blood flow in the ankle and arm using a doppler ultrasound device. After measuring blood flow, doctors calculate the ratio of blood pressure in the ankle to blood pressure in the arm. A normal ABI ratio is between 1 and 1.4. An ABI ratio of:

• 0.9-0.99 indicates mild PAD
• 0.4 – 0.89 indicates moderate PAD 

An abnormally low ankle-brachial index ratio (less than 0.4) is indicative of severe PAD. 

Doppler Ultrasound and Duplex Ultrasound

A doppler ultrasound uses sound waves to identify blocked or narrow blockages. A duplex ultrasound generates real-time images of arteries, helping doctors identify plaques, stenosis (narrowing), and blockages. It combines doppler ultrasound with B-mode imaging to provide information about the structure of arteries. 

Treadmill Exercise Test

A patient taking this test walks on a treadmill at a standard speed and incline (usually 2 mph at a 12% incline for up to 5 minutes). A significant decrease in ABI once they stop suggests reduced blood flow to the legs (often caused by PAD). 

Toe-Brachial Index (TBI) Test

Often used to diagnose PAD in patients with diabetes and CKD and older adults, a TBI test involves measuring blood pressure in the toes using a doppler device, and comparing it with blood pressure in the arm. Toe systolic pressure is divided by brachial systolic pressure to get the TBI ratio. A TBI of 

• ≥ 0.7 is considered normal
• 0.6 - 0.69 indicates borderline PAD

Peripheral Artery Disease Treatment

Effective treatment addresses PAD symptoms, improves mobility, and prevents ulcers and other serious complications. Depending on the severity of the condition and the patient’s overall health, a doctor may explore the following treatment options:

Medications 

The following medications can help manage PAD symptoms 

• Aspirin and Clopidogrel (Plavix) -Can help prevent blood clots
• Atorvastatin (Lipitor) and Rosuvastatin (Crestor)- Can help lower LDL ("bad") cholesterol levels 
• Lisinopril and Losartan- Help reduce high blood pressure-a risk factor for PAD 

Minimally Invasive Procedures 

When medications do not work, doctors perform the following procedures to treat PAD:

• Balloon Angioplasty - A catheter with a small balloon is inserted into the narrowed artery and inflated to widen it
• Stenting - A small metal mesh tube (stent) is placed into the narrowed artery to keep it open
• Atherectomy- A small cutting device or laser is used to remove plaque from arteries

Surgery

When PAD leads to critical limb ischemia or formation of non-healing ulcers, doctors may perform the following surgeries

• Bypass surgery- A graft is used to bypass the blocked artery
• Endarterectomy- The affected artery is opened and plaque is removed 

Emerging Therapies 

In some cases, advanced therapies such as gene & stem cell therapy and extracorporeal shockwave therapy are used to treat PAD.

• Gene & stem cell therapy- Encourages new blood vessel growth and repairs damaged tissues
• Extracorporeal shockwave therapy - Improves blood flow in the affected limb

Peripheral Artery Disease (PAD) can lead to serious health risks if left untreated. As blood flow to the limbs is restricted due to narrowed arteries, the lack of oxygen-rich blood can result in several complications, including:

• Critical Limb Ischemia (CLI): A severe stage of PAD where reduced circulation causes chronic pain, sores, or infections in the legs and feet, potentially leading to tissue death (gangrene) and amputation.
• Non-Healing Wounds & Ulcers: Poor blood flow slows the body’s ability to heal, increasing the risk of infections that may become life-threatening.
• Infections & Gangrene: Reduced immunity and circulation can lead to severe infections, which may require surgical intervention or, in extreme cases, limb amputation.
• Increased Risk of Heart Attack & Stroke: Since PAD is caused by atherosclerosis (plaque buildup in the arteries), individuals with PAD are at higher risk of cardiovascular complications, including heart attacks and strokes.
• Mobility Issues & Muscle Weakness: Chronic pain and reduced blood supply to the legs can lead to difficulty walking, muscle weakness, and a decreased quality of life.

Early diagnosis and proper management of PAD are crucial to reducing the risk of these complications and maintaining overall vascular health.

One can significantly reduce their risk of developing PAD by following these easy, yet effective PAD prevention tips:

Lifestyle Modifications

Because smoking can worsen PAD symptoms, people at high risk of developing the health condition should steer clear of tobacco products. They must exercise regularly and eat a healthy, balanced diet comprising foods low in harmful fats to reduce their risk of health conditions (such as diabetes, hypertension, and high cholesterol) that can lead to PAD.

Stay Hydrated

A blood clot can obstruct blood flow. Water helps maintain optimum blood viscosity (thickness), reducing the risk of clot formation. Proper hydration keeps blood vessels flexible and responsive, reducing the risk of atherosclerosis (hardening of arteries), a leading cause of PAD.

Realise the Importance of Regular Health Check-Ups

Regular health check-ups can help doctors diagnose health conditions that can lead to PAD. If an individual is at high risk for diabetes and other health conditions that can cause arteries to narrow, their doctor can recommend dietary modifications, exercise plans, or smoking cessation programs. During a health check-up, a doctor can assess leg pain and numbness, and examine slow-healing wounds to determine if they are caused by PAD.

Avoid Prolonged Sitting or Standing

Though prolonged sitting and standing alone cannot directly lead to PAD, it can contribute to atherosclerosis by causing blood to pool in the lower extremities, which increases pressure in the veins and arteries.

Can PAD affect my ability to work?

It depends on the severity. If symptoms are mild, many people continue working with accommodations like frequent breaks. However, severe PAD may limit physical activity and require job modifications.

Can PAD cause leg cramps at night?

Yes, reduced blood flow can cause cramps or pain in the legs, particularly at night or when the legs are elevated. Keeping the legs warm and adjusting sleeping positions may help.

Is it safe to undergo other surgeries if I have PAD?

PAD increases surgical risks, especially for heart and vascular complications. A thorough preoperative evaluation is necessary to assess risks and plan accordingly.

Does PAD affect both legs equally?

Not always. Some patients experience more severe symptoms in one leg due to differences in arterial blockage levels.

Is PAD a sign of other underlying health problems?

Yes, PAD is strongly linked to cardiovascular disease, diabetes, and high cholesterol. It often signals a higher risk of heart attacks or strokes.

Can PAD cause erectile dysfunction?

Yes, PAD can lead to erectile dysfunction (ED) by reducing blood flow to the pelvic region. Treating PAD and improving vascular health can help manage ED.

Does PAD increase the risk of kidney disease?

Yes, since PAD affects blood vessels throughout the body, it can also impair kidney function, especially in people with high blood pressure or diabetes.

Are people with diabetes at a higher risk of PAD progression?

Yes, diabetes accelerates arterial damage, increasing the likelihood of severe PAD, critical limb ischemia, and amputations if not managed properly.

Is PAD hereditary?

While PAD itself is not directly inherited, a family history of vascular diseases, high cholesterol, or diabetes can increase the risk.

Can PAD lead to sudden cardiac events?

Yes, because PAD is associated with atherosclerosis (narrowing of the arteries), it significantly increases the risk of sudden heart attacks and strokes.

Are women at a higher risk of complications from PAD?

Women with PAD often have more severe symptoms and a higher risk of heart-related complications compared to men. They are also less likely to be diagnosed early.

Reviewed by Dr. Aditya Kumar Singh, Associate Director - Unit Head CTVS, Cardiac Sciences, Cardiac Surgery (CTVS), on 14 May 2025. 

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