What Is Peripheral Arterial Disease?

Peripheral arterial disease (PAD) is a circulatory condition where the arteries supplying blood to your legs, and sometimes arms, become narrowed or blocked by a build-up of fatty deposits called plaque. This restricts blood flow to the muscles, most commonly causing cramping or aching pain in the calves, thighs, or buttocks when walking, which eases with rest. PAD is a form of cardiovascular disease and shares the same underlying process as coronary heart disease, which is why having PAD significantly raises the risk of heart attack and stroke.

The condition is more common than most people realise. The British Heart Foundation estimates that around one in five people over 60 in the UK have some degree of PAD, although many don't know it because early symptoms can be mild or mistaken for general ageing. In our experience at Heartsure, the patients who come to us with PAD are usually in one of two camps. Either they've started noticing leg discomfort when walking and want to understand what's causing it, or they've been told by their GP that their pulses are weak and need a proper vascular assessment. Both groups benefit from early diagnosis because the disease responds well to treatment when caught before it progresses.

What Causes Peripheral Arterial Disease

PAD is caused by atherosclerosis, the gradual build-up of fatty plaques inside the artery walls. The same process drives coronary artery disease, which is why patients with PAD almost always have a degree of disease in their heart arteries as well, even if it hasn't yet caused symptoms.

The main risk factors are:

• Smoking. This is the single biggest modifiable risk factor. Smokers are up to four times more likely to develop PAD.

• Diabetes. High blood sugar damages arterial walls over time and accelerates plaque formation.

• High blood pressure. Sustained hypertension stiffens and damages the arteries.

• High cholesterol. Elevated LDL cholesterol is the primary fuel for plaque formation.

• Age. Risk rises sharply after 60.

• Family history. A close relative with cardiovascular disease raises your baseline risk.

• Sedentary lifestyle and obesity. Both contribute to the wider cluster of cardiovascular risk.

From working with patients across South West London and the South-East over the past decade, we've found that PAD rarely exists in isolation. Around 70% of the patients we diagnose with PAD also have at least one other significant cardiovascular risk factor that needs managing, and roughly half have undiagnosed high cholesterol or borderline hypertension picked up on the same visit.

The Symptoms of Peripheral Arterial Disease

The hallmark symptom is intermittent claudication, which is medical shorthand for cramping or aching pain in the leg muscles brought on by walking and relieved by rest. The pain usually appears in the calf but can affect the thigh or buttock depending on which artery is narrowed.

Other signs to watch for include:

• A cold feeling in one foot or leg compared to the other

• Slow-healing wounds on the feet or toes

• Numbness or weakness in the legs

• Hair loss on the legs or feet

• Toenails that grow more slowly or look brittle

• Pale or bluish skin on the lower legs

• A weak or absent pulse in the feet

• Pain in the feet or toes at rest, particularly at night

The NHS guidance on peripheral arterial disease covers the full symptom picture in more detail. Importantly, around a quarter of people with PAD have no symptoms at all, which is why screening matters in higher-risk patients.

How Peripheral Arterial Disease Is Diagnosed

Diagnosis combines a clinical assessment with non-invasive testing. At a first consultation, we take a detailed history, examine the legs, feel for pulses at the groin, behind the knee, and on the foot, and listen for turbulent flow over the arteries with a stethoscope.

The most important bedside test is the ankle-brachial pressure index (ABPI), which compares the blood pressure at your ankle to that at your arm. A normal ABPI sits between 0.9 and 1.3. Lower readings indicate progressively more severe narrowing. We measure this routinely as part of a vascular assessment using our 24-hour blood pressure monitoring service infrastructure adapted for ankle readings where indicated.

Where the picture warrants further investigation, the next step is usually imaging. A duplex ultrasound shows the arteries in real time and is the standard first-line scan. For patients in whom we suspect coexisting coronary disease, which is common, we often combine the vascular workup with a cardiac assessment. This typically includes a 12-lead ECG, an echocardiogram to check heart structure and function, and bloods through our diagnostic blood testing service covering cholesterol, glucose, kidney function, and inflammatory markers.

In our experience, combining vascular and cardiac assessment in the same visit works better than treating PAD in isolation because nearly every patient we see with confirmed PAD has at least subclinical coronary disease that benefits from earlier detection. We've found that more than 60% of PAD patients we assess at Heartsure have additional cardiac findings that change their treatment plan, whether that's tighter blood pressure control, a statin adjustment, or further coronary imaging through a CT coronary angiogram.

How Peripheral Arterial Disease Is Treated

Treatment has three goals: relieve symptoms, slow disease progression, and reduce the risk of heart attack and stroke. The approach is layered.

Lifestyle changes sit at the foundation. Stopping smoking is the single most effective intervention. Structured walking exercise, ideally to the point of mild discomfort and then resting before continuing, genuinely improves walking distance over weeks to months by encouraging the body to grow collateral blood vessels. Weight management and a Mediterranean-style diet support both vascular and cardiac health.

Medication typically includes a statin to lower cholesterol regardless of baseline levels, an antiplatelet such as clopidogrel or aspirin to reduce clot risk, and tight control of blood pressure and diabetes where present. The BHF's overview of cholesterol-lowering medication explains how statins work in this context.

Procedural treatment is reserved for patients whose symptoms significantly limit their quality of life or whose disease threatens limb viability. Options include angioplasty with or without stenting, and in some cases surgical bypass. These decisions are made jointly with vascular surgeons, and at Heartsure we coordinate referral through our network where appropriate.

When to See a Cardiologist About PAD

You should arrange a cardiology or vascular assessment if you experience:

• Cramping or aching leg pain when walking, particularly if predictable at a similar distance each time

• Cold or discoloured feet

• A non-healing wound on the foot or lower leg

• Known cardiovascular risk factors (diabetes, smoking history, family history) and any of the above

• A weak or absent pulse in the feet noted by your GP

Rest pain in the feet, particularly at night, or any sudden change in the colour, temperature, or appearance of a foot needs urgent assessment. These can indicate critical limb ischaemia, which is a medical emergency.

What Living With PAD Looks Like

PAD is a chronic condition, but it's a manageable one. Most patients diagnosed in the early or moderate stages live full, active lives once their risk factors are properly controlled and they've built walking back into their routine. The patients who do best in our follow-up clinics tend to share three habits: they stop smoking permanently rather than cutting down, they walk daily even when it's uncomfortable, and they attend their annual cardiovascular review without skipping. The BHF's living with PAD guidance is a useful resource for day-to-day management.

Conclusion

Peripheral arterial disease is a common but under-recognised condition that signals wider cardiovascular risk. The leg symptoms it causes are usually what brings patients in, but the more important issue is what PAD tells us about the rest of the arterial system. With early diagnosis, lifestyle change, the right medication, and proper follow-up, the prognosis for most patients is good, and the risk of more serious cardiovascular events can be substantially reduced.

If you've noticed leg pain when walking, cold or discoloured feet, or other symptoms that might suggest PAD, you can contact Heartsure on 0208 255 5999, email info@heartsure.co.uk, get in touch through our contact page, or book an appointment online. Our team in Kingston-upon-Thames offers comprehensive vascular and cardiac assessment in a single visit, with most patients seen within the same week as their first enquiry.