Do You Have These Early Signs of Peripheral Arterial Disease?

Peripheral arterial disease (PAD) is a common yet underdiagnosed circulatory disorder characterized by the narrowing of arteries supplying blood to the limbs, most often affecting the legs and feet. The reduction in blood flow, frequently caused by arterial plaque buildup, leads to symptoms like leg pain during walking, poor wound healing, and, in advanced cases, severe infection or amputation. 

Beyond limb complications, PAD is a clear marker for elevated risk of heart attack and stroke, according to experts with Baptist Health Heart & Vascular Care.

PAD in the legs is often a sign of broader atherosclerosis, which is nothing more than plaque buildup within the arteries of the body regardless of location, says Baptist Health’s Rennier Alejandro Martinez, M.D., a general and vascular surgeon with a dedicated fellowship in vascular surgery and a professional focus on complex vascular conditions including advanced 

endovascular aortic repair, carotid artery stenting and limb salvage.

“When we find PAD, we must look at the patient’s overall cardiovascular risk and focus on identifying concomitant disorders such as heart disease which can lead to a heart attack, carotid artery disease which can lead to strokes, and aneurysmal disease which can lead to life threatening bleeding or complications,” Dr. Martinez notes.

Understanding PAD and its Risk Factors

PAD develops when fatty deposits called atherosclerosis accumulate in peripheral arteries, restricting the flow of oxygen-rich blood. While early stages may be asymptomatic, common complaints for people with PAD include cramping or fatigue in the legs during physical activity (claudication), which is quickly relieved by rest. 

Dr. Martinez says that as the disease progresses, individuals may experience pain even at rest, nonhealing sores, changes in skin color or temperature, or loss of pulses in the foot. Such symptoms signal advanced disease requiring urgent assessment, he stresses.

“PAD risk increases with advancing age, particularly after 50, and is further elevated by diabetes, smoking (current or former), high blood pressure, high cholesterol, chronic kidney disease and family history of early cardiovascular disease,” says Dr. Martinez. Diabetes and tobacco use increase the risk for delayed wound healing and limb amputation if PAD is not managed appropriately, he adds.

Though PAD affects both sexes, women are sometimes underdiagnosed, as they may present with atypical symptoms or seek care later. Black adults face higher prevalence and more severe complications with PAD, including limb loss. 

“Even in the absence of classical complaints, at-risk individuals—especially those with diabetes or a history of smoking—should undergo screening,” advises Dr. Martinez.

PAD Prevalence and Significance

PAD affects an estimated 12 million U.S. adults, according to the American College of Cardiology, with prevalence rising sharply for those over 70. However, many cases go undetected, as symptoms may not be classic or individuals may adapt their activity to avoid discomfort.

“Many people assume their leg pain is simple aging or arthritis but if the pain reliably occurs with walking and subsides at rest, it can suggest a vascular cause,” says Nicholas Cortolillo, M.D., a vascular specialist at Baptist Health Heart & Vascular Care. 

“The good news is that PAD is treatable. However, early detection and intervention remain critical for reducing complications from this disease and improving the patient’s quality of life,” Dr. Cortolillo says.

Recognizing the Symptoms of PAD

PAD typically presents with claudication, which happens when the patient experiences exertional leg pain—such as cramping, heaviness or weakness in the calf, thigh or buttock—that goes away with rest. Other signs of PAD include persistent numbness, coldness in a lower leg or foot, nonhealing sores or ulcers, changes in skin color or hair growth and weak or absent pulses. 

Some men may also experience erectile dysfunction when PAD is present, Dr. Cortolillo says. Also, older adults and those with diabetes may have atypical symptoms, making a thorough evaluation essential. 

For patients with diabetes, doctors keep a close eye on their feet, says Dr. Cortolillo. “A nonhealing foot ulcer in a patient with diabetes should be treated as a vascular emergency,” he says, adding that “routine checks and low thresholds for reporting concerns” are the best defense against serious complications.

How is PAD Diagnosed?

The diagnostic process for PAD is systematic and minimally invasive, according to Dr. Cortolillo. It starts with the patient’s medical history and a focused physical exam that may include one or more of the following tests:

• Ankle-Brachial Index (ABI): This comparative blood pressure test between the arm and ankle is a primary screening tool. A low ABI indicates impaired blood flow and confirms PAD.
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• Ultrasound Imaging: Duplex ultrasonography assesses blood flow and identifies specific sites of narrowing.
   
• Advanced Imaging: In certain cases, CT angiography or MR angiography provides detailed mapping of arterial blockages, especially if intervention is considered.
   
• Catheter-Based Angiography: Often reserved for complex or procedural planning, this technique visualizes arteries from the inside and may be combined with treatment.

Non-invasive testing such as ABI and ultrasound provides rapid, informative results, Dr. Cortolillo points out, while advanced scans are reserved for those likely to benefit from revascularization.

Treatment Strategies

Management of PAD has two primary goals, according to Dr. Martinez. “We want to reduce cardiovascular risk in order to protect the heart and brain, and also enhance limb blood flow to preserve mobility and preventing serious complications.”

Treatment plans for PAD are individualized, Dr. Martinez says, but they typically encompass three primary strategies:

1.     Lifestyle Modification

Comprehensive lifestyle changes form the foundation of PAD management. Smoking cessation is essential, as tobacco use accelerates vessel injury and increases risks of amputation, heart attack, and stroke.

Regular, structured walking (or supervised exercise rehabilitation) is proven to improve pain-free walking distance and overall function. Studies show that the majority of peripheral arterial disease can be treated with regular exercise and best medical therapy which strengthens the heart and helps the body build new channels for blood flow to travel.

A heart-healthy diet, ideally patterned after the Mediterranean model, supports blood pressure, cholesterol and weight control. For those with diabetes or high cholesterol, tight glycemic and lipid management are especially important. Daily foot care—including protective footwear and careful monitoring for wounds—prevents ulcers and reduces infection risk.

2.     Medications

Pharmacotherapy for PAD primarily targets risk factor reduction and symptom relief:

• Antiplatelet Agents: Aspirin or clopidogrel lowers the risk of heart attack and stroke.

• Statins: High-intensity statins reduce cholesterol and cardiovascular events.

• Blood Pressure and Glucose Control: ACE inhibitors or ARBs, alongside customized diabetes management, preserve vascular integrity.

• Symptom Relief: Cilostazol, an antiplatelet with vasodilatory effect, may improve walking capacity in selected patients, though not everyone is a candidate.

3.     Revascularization

For patients with severe symptoms, lifestyle limitations or nonhealing wounds, revascularization becomes necessary. Less invasive endovascular procedures—such as balloon angioplasty, stent placement and atherectomy—are often preferred due to shorter recovery times. Surgical bypass offers a durable solution for extensive disease, especially when endovascular options are insufficient. The choice of intervention is tailored to the individual’s anatomy, comorbidities and functional goals.

Evolving Approaches and New Therapies

Ongoing research is rapidly expanding treatment options for PAD, particularly for individuals with complex or treatment-refractory cases, Dr. Martinez says. Notable advancements include:

• Minimally Invasive Bypass: Percutaneous transmural arterial bypass (PTAB) employs advanced endovascular technology to create a bypass around blocked arteries through the patient’s own blood vessels. Unlike open bypass surgery, PTAB is performed via small punctures, decreasing surgical complications and allowing faster recovery.

• 2. GLP-1 Receptor Agonists: These medications, first developed to treat diabetes and obesity, are being studied in PAD for their potential to improve walking performance, reduce pain and decrease both limb- and heart-related adverse events. 

• Cell-Based Regenerative Therapies: Innovative cell-based approaches, particularly with mesenchymal stem cells, are under investigation to stimulate new blood vessel growth (angiogenesis), improve tissue perfusion, and accelerate wound healing in severe PAD and critical limb ischemia. 

With PAD, Early Diagnosis Matters 

PAD presents a substantial challenge but remains manageable when detected early and approached systematically, says Dr. Cortolillo.

“If you suspect you or a loved one may have PAD, do not delay—testing is simple and treatments are effective,” he says. “Prompt recognition and a coordinated treatment plan yield notable improvements in pain-free walking, limb preservation and overall health.”

With an understanding of individual risk factors, attention to classic and atypical symptoms, and adherence to evidence-based prevention and treatment strategies, Dr. Cortolillo and Dr. Martinez both agree that most patients can preserve limb function and minimize the risk of serious cardiovascular events.

Click here for more information about Baptist Health Heart & Vascular Care.

Rennier Alejandro Martinez, M.D., a general and vascular surgeon with Baptist Health Heart & Vascular Care

Nicholas Cortolillo, M.D., a vascular specialist with Baptist Health Heart & Vascular Care