Peripheral Arterial Disease

Peripheral arterial disease is narrowing of the arteries supplying the legs (and occasionally the arms), usually due to atherosclerosis, reducing blood flow to the limbs. It shares many risk factors with heart disease and stroke and signals broader cardiovascular risk.

• Leg pain, cramping, or fatigue with walking that improves with rest (intermittent claudication), typically in the calf
• Cold feet or legs compared to the rest of the body
• Weak or absent pulses in the feet
• Slow-healing wounds or sores on the feet or legs
• In severe disease: pain at rest, and skin changes such as hair loss or shiny skin on the legs

• Caused by atherosclerosis (fatty plaque build-up) narrowing the arteries supplying the legs, reducing blood flow, particularly during exertion.
• Major risk factors include smoking, diabetes, hypertension, high cholesterol, and older age — largely the same risk factors as for heart attack and stroke.

• Suspected based on the characteristic pattern of leg pain with walking that eases with rest, together with examination findings such as reduced pulses or cool skin.
• The ankle-brachial index, comparing blood pressure in the ankle and arm, is a simple test that supports the diagnosis where available.
• Further vascular imaging may be used to assess the location and severity of arterial narrowing, particularly if intervention is being considered.

Structured walking exercise is a key part of treatment, as it can significantly improve walking distance and symptoms over time by promoting the development of alternative blood flow routes.

Aggressive control of cardiovascular risk factors — stopping smoking, and managing blood pressure, diabetes, and cholesterol — is essential, both for leg symptoms and to reduce the risk of heart attack and stroke.

A statin and, often, an antiplatelet medicine such as aspirin are commonly prescribed to reduce cardiovascular risk.

Severe disease with pain at rest, non-healing wounds, or critical limb ischaemia requires referral to a specialist for consideration of procedures to restore blood flow, given the risk of limb loss if untreated.

Careful foot care is important to prevent and detect wounds early, given the reduced blood flow and healing capacity.

• Avoid smoking, which is one of the strongest risk factors for peripheral arterial disease.
• Control blood pressure, diabetes, and cholesterol.
• Engage in regular walking exercise, ideally following a structured, gradually increasing programme.
• Check the feet regularly for cuts, sores, or colour changes, and seek prompt care for any wounds that are slow to heal.