A short story: what would you do?
Follow Mang Lito to learn the warning signs and what to do. Turn on your sound for the narration.
What happens to the blood vessels
Arteries are the tubes that carry blood rich in oxygen from your heart to your body. In PAD, fatty deposits called plaque build up inside the arteries of the legs. Over time the arteries become narrow or blocked. [Ref: ACC/AHA/SVM 2024 PAD]
When you rest, enough blood may still get through. When you walk, your leg muscles need more oxygen than the narrowed arteries can deliver. That is why the legs hurt with walking and feel better with rest. [Ref: ACC/AHA/SVM 2024 PAD] [Ref: ESC 2024 PAAD]
The plaque that narrows leg arteries is the same kind that causes heart attacks and strokes. Having PAD means the arteries elsewhere in your body may be affected too. People with PAD have a higher risk of heart attack, stroke and amputation. [Ref: ACC/AHA/SVM 2024 PAD] [Ref: ESC 2024 PAAD]
How common is PAD?
Many people with PAD have no symptoms at all. It is one of the most under-diagnosed artery diseases, including in the Asia-Pacific region. [Ref: APSAVD 2020 Asia-Pacific PAD]
Worldwide, about 113 million people aged 40 and older were living with PAD in 2019, and the number keeps growing. [Data: GBD 2019 PAD] In the Philippines, a national survey counted PAD in about 1 in 100 adults. [Data: Sy 2012] But when doctors in Manila checked the ABI of people with diabetes who had no leg symptoms, about 1 in 3 had PAD. [Data: Pleo 2012] Many people simply do not know they have it.
Who is most at risk: smoking (now or in the past), diabetes, high blood pressure, high cholesterol, chronic kidney disease, older age, and a history of heart disease or stroke. [Ref: ACC/AHA/SVM 2024 PAD] [Ref: ESC 2024 PAAD]
Symptoms and red flags
Doctors group PAD into four stages. Knowing yours tells you how quickly you need care. [Ref: ACC/AHA/SVM 2024 PAD]
| Stage | What you may notice | What to do |
|---|---|---|
| No symptoms | Nothing, or you walk more slowly without knowing why | Get checked if at risk |
| Claudication | Cramping, aching or tired calves, thighs or buttocks when walking. It eases within minutes of rest and comes back at about the same distance. | Book a clinic visit |
| Chronic limb-threatening ischemia (CLTI) | Foot pain at rest, often at night. A sore that does not heal after 2 weeks. Black or dying skin on toes (gangrene). | See a specialist within days Go to the emergency room now if the sore has spreading redness, pus, a bad smell or fever. |
| Acute limb ischemia | A leg that suddenly becomes cold, pale, painful, numb or weak | Go to the ER now |
[Ref: ACC/AHA/SVM 2024 PAD] [Ref: GVG 2019 CLTI] [Ref: ESC 2024 PAAD]
Claudication vs. rest pain
Claudication
Happens with activity and goes away with rest. It does not usually threaten the leg. It is a strong sign of narrowed arteries and higher heart and stroke risk. [Ref: ACC/AHA/SVM 2024 PAD]
Rest pain
Happens without activity, often in the toes or front of the foot, and often at night. Some people sleep sitting up or hang the leg off the bed for relief. It means blood flow is too low to keep the foot alive and needs prompt care. [Ref: GVG 2019 CLTI]
Other signs your doctor may find: weak or missing foot pulses, cool skin, shiny hairless skin on the shins, slow-growing toenails, or one foot paler than the other. [Ref: ACC/AHA/SVM 2024 PAD]
What happens at your check-up
Most PAD is found with a careful history, a physical exam and a simple test called the ankle-brachial index. [Ref: ACC/AHA/SVM 2024 PAD] [Ref: ESC 2024 PAAD]
Ankle-brachial index (ABI)
You lie down for a few minutes. A nurse or technician measures your blood pressure in both arms and both ankles using cuffs and a small handheld ultrasound probe. The ankle number is divided by the arm number. The test is quick and does not hurt. [Ref: ACC/AHA/SVM 2024 PAD]
Your doctor will explain what your result means for you.
[Ref: ACC/AHA/SVM 2024 PAD] [Ref: ESC 2024 PAAD]
Toe-brachial index (TBI)
Some people with diabetes or kidney disease have stiff ankle arteries that give falsely high ABI numbers. A small cuff on the big toe gives a more accurate reading. [Ref: ACC/AHA/SVM 2024 PAD] [Ref: ESC 2024 PAAD] [Ref: IWGDF/ESVS/SVS 2023 Diabetes and PAD]
Exercise ABI
If your symptoms sound like PAD but your resting ABI is normal or borderline, you may walk on a treadmill and have the ABI repeated afterwards. [Ref: ACC/AHA/SVM 2024 PAD] [Ref: ESC 2024 PAAD]
Arterial duplex ultrasound
Uses sound waves to show where an artery is narrowed or blocked and how blood is flowing. No radiation and no dye. It is the first imaging test for most people when the exact location of a blockage matters. [Ref: ESC 2024 PAAD] [Ref: ACC/AHA/SVM 2024 PAD]
CT, MR or catheter angiography
Detailed scans that map the arteries. They are usually done only when a procedure to open the artery is being planned. [Ref: ACC/AHA/SVM 2024 PAD] [Ref: ESC 2024 PAAD]
Your doctor decides which tests you need and explains what the results mean for you.
Leg pain when walking? Get your arteries checked.
Only an examination and simple tests can tell whether you have PAD and how it should be treated. Dr. Aaron Christopher P. Novales sees patients with PAD.
A leg or foot that suddenly turns cold, pale or numb? Do not wait for a clinic visit. Go to the emergency room now →
How PAD is managed
About the medicines on this page
Medicines are described here only to help you understand your doctor's plan. Do not buy or take any medicine because you read about it here. Take only what your doctor prescribes for you, and never start, stop or change a dose on your own.
Treatment has two goals: protect your heart and brain, and help your legs. Almost everyone with PAD benefits from lifestyle changes and medicines. Only some people need a procedure. [Ref: ACC/AHA/SVM 2024 PAD] [Ref: ESC 2024 PAAD]
Stop smoking, completely
This is the single most important step. It lowers the risk of heart attack, stroke and amputation. Counselling and stop-smoking medicines can help you quit. Avoid second-hand smoke too. [Ref: ACC/AHA/SVM 2024 PAD] [Ref: ESC 2024 PAAD]
Structured walking exercise
Regular walking is one of the best treatments for claudication. In a supervised program, you walk until the leg pain is moderate, rest until it passes, then walk again. [Ref: ACC/AHA/SVM 2024 PAD] [Ref: ESC 2024 PAAD]
30–60 minper session
3+ timesa week
12+ weeksto see results
If a supervised program is not available, a structured home or community program guided by your care team also helps. [Ref: ACC/AHA/SVM 2024 PAD] [Ref: ESC 2024 PAAD]
Ask your doctor to plan a walking program that is safe for you.
Medicines that protect your arteries
- Cholesterol-lowering medicine. Recommended for everyone with PAD. Your doctor chooses the medicine and the dose to reach your cholesterol goal. [Ref: ACC/AHA/SVM 2024 PAD] [Ref: ESC 2024 PAAD]
- Blood-thinning medicine. People with leg symptoms usually take one medicine that prevents clots (an antiplatelet). Some people at high risk may need a second one. Your doctor will decide. Do not start or stop any blood thinner on your own. [Ref: ACC/AHA/SVM 2024 PAD] [Ref: ESC 2024 PAAD]
- Blood pressure control. Keeping blood pressure in your target range lowers heart and stroke risk. [Ref: ACC/AHA/SVM 2024 PAD] [Ref: ESC 2024 PAAD]
- Diabetes control. Some newer diabetes medicines also protect the heart and blood vessels. Ask whether one is right for you. [Ref: ACC/AHA/SVM 2024 PAD]
- Medicine for walking distance. Some people may be prescribed a medicine that helps them walk farther. It is not safe for everyone, including people with heart failure. [Ref: ACC/AHA/SVM 2024 PAD]
Foot care
Check your feet every day for cuts, blisters or colour changes. Wear well-fitting shoes; do not walk barefoot. See your doctor about any sore that is not healing. This matters most if you have diabetes. [Ref: ACC/AHA/SVM 2024 PAD] [Ref: IWGDF/ESVS/SVS 2023 Diabetes and PAD] Read the diabetic foot guide.
Procedures to restore blood flow
A vascular specialist can open or bypass a blocked artery (revascularization). This can be done with a balloon or stent through a small puncture, with open surgery, or with both. [Ref: ACC/AHA/SVM 2024 PAD] [Ref: ESC 2024 PAAD]
Your vascular specialist will discuss whether a procedure would help you. For leg pain on walking, exercise and medicines come first. A procedure is usually needed for pain at rest, a wound that will not heal or gangrene, and as an emergency for a leg that suddenly turns cold and painful.
[Ref: ACC/AHA/SVM 2024 PAD] [Ref: ESC 2024 PAAD] [Ref: GVG 2019 CLTI]
After a procedure, you still need your medicines, walking program and foot care. Regular follow-up checks your legs and arteries. [Ref: ACC/AHA/SVM 2024 PAD]
Talk to your doctor about
Bring these questions to your visit.
- Do I need an ABI test?
- What is my PAD stage?
- What are my cholesterol and blood pressure goals?
- Is a supervised walking program available near me?
- Which blood thinner is right for me?
Guideline sources for this page
- ACC/AHA/SVM 2024 PAD: Gornik HL, et al. 2024 ACC/AHA multisociety guideline for lower extremity PAD. Circulation 2024;149:e1313–e1410.
- ESC 2024 PAAD: Mazzolai L, et al. 2024 ESC Guidelines for peripheral arterial and aortic diseases. Eur Heart J 2024;45:3538–3700.
- APSAVD 2020 Asia-Pacific PAD: Abola MTB, et al. Asia-Pacific Consensus Statement on the Management of PAD. J Atheroscler Thromb 2020. Co-funded by PSVM.
- GVG 2019 CLTI: Conte MS, et al. Global Vascular Guidelines on CLTI (ESVS/SVS/WFVS). Eur J Vasc Endovasc Surg 2019.
- IWGDF/ESVS/SVS 2023 Diabetes and PAD: Fitridge R, Chuter V, Mills JL, et al. The intersocietal IWGDF, ESVS, SVS guidelines on peripheral artery disease in people with diabetes and a foot ulcer. Diabetes Metab Res Rev 2024;40:e3686.
- Prevalence data: GBD 2019 PAD; Sy 2012 (NNHeS II); Pleo 2012 (JAFES).