Healthy circulation of the blood is essential for all vital organs and tissues in your body. Therefore, conditions like peripheral arterial disease, or PAD, can pose a serious threat to your health. With the help of a vascular physician specializing in peripheral arterial disease treatment in Houston, you can resolve the symptoms of PAD and improve your circulatory health. Read on for a closer look at this condition and the treatment options that may be available to you.
Quick Answer: Peripheral artery disease (PAD) is narrowing of the arteries that carry blood to the legs, caused by plaque buildup. The classic symptom is cramping or aching in the calf, thigh or buttock with walking that eases within minutes of rest, but many people have no symptoms at all. PAD is diagnosed with a simple ankle-brachial index test, and most patients are treated first with walking exercise, quitting smoking and medicines, with angioplasty or stenting reserved for limiting symptoms or threatened limbs.
Meet your vein specialist
Dr. Syed Raza, MD
Vascular & Interventional Radiology · Founder, Premier Vein & Vascular Center
Fellowship-trained interventional radiologist certified by the American Board of Radiology and the Royal College of Radiologists (UK). Former Chief of Interventional Radiology at UTMB Galveston and Memorial Hermann Memorial City, with 15+ years treating varicose veins, venous reflux and peripheral arterial disease.
What Are the Signs of PAD?
With peripheral artery disease, the extremities begin to experience reduced blood flow due to the buildup of plaque along the inner artery walls—a process known as atherosclerosis. As the condition develops, you may notice symptoms of pain with walking, numbness, slow-healing sores on the legs and feet, poor nail growth, or discoloration of the skin. However, PAD often presents no symptoms at all, so your doctor should check for this condition if you are over the age of 70, over age 50 and have diabetes or a history of smoking, or have had a heart attack or stroke.
What Causes PAD?
The exact causes of PAD are not yet known, though there is a clear link between a number of risk factors and the buildup of plaque in the arteries. Cigarette smoking, insulin resistance and diabetes, high blood cholesterol, and high blood pressure all increase the risk of PAD. Lifestyle changes can minimize these risk factors and help you avoid more complex and invasive treatments.
What Are the Long-Term Effects of PAD?
Without treatment, PAD can lead to open sores and wounds on the legs, worsening leg pain, and gangrene, and limb loss.
What Can Be Done to Treat PAD?
While lifestyle changes (such as quitting smoking and increasing your exercise) may be enough to treat PAD in its early stages, you may need other treatments for severely narrowed arteries in the legs. Treatment options include stent placement and balloon angioplasty, which will use a catheter to reopen the arteries and restore healthy blood flow. Other treatments include atherectomy, arteriograms, and thrombolysis. To learn more about Peripheral Arterial Disease contact us today.
Understanding Peripheral Artery Disease: How the Arteries Narrow
Arteries carry oxygen-rich blood from the heart to every muscle in the legs. In PAD, cholesterol, inflammatory cells and calcium gradually build up inside the artery wall and form plaque. As plaque grows, the channel narrows, and the artery can no longer increase blood flow when the muscles need more oxygen.
At rest, a narrowed artery may still deliver enough blood, which is why many people feel fine sitting down. During walking, though, the calf and thigh muscles demand several times more oxygen. When supply cannot keep up, the muscles cramp and ache. Stop walking, and demand falls back to what the narrowed artery can deliver, so the pain fades. That simple supply-and-demand mismatch explains the most recognizable symptom of PAD.
PAD is also a signal about the rest of the body. The same process that narrows the leg arteries usually affects the arteries of the heart and brain, so people with PAD have a higher risk of heart attack and stroke. Treating PAD well means protecting the legs and the whole circulation.
Claudication and Other PAD Symptoms Explained
The medical term for walking-related leg pain is intermittent claudication. Where you feel it hints at where the blockage is:
- Buttock or hip pain suggests narrowing in the arteries of the pelvis
- Thigh pain points to the arteries at the top of the leg
- Calf pain, the most common pattern, usually reflects narrowing in the thigh or behind the knee
- Foot pain or numbness with walking can come from disease in the arteries below the knee
Many people do not describe classic cramping. Instead they slow down, walk less, blame age or arthritis, or notice that their legs simply tire before their breathing does. In people with diabetes, nerve damage can blunt pain, so PAD may first show up as a foot wound that will not heal.
Signs we look for on examination
- Weak or absent pulses in the feet or behind the knee
- Cool feet, or one foot cooler than the other
- Shiny, thin skin and loss of hair on the lower legs and toes
- Thick, slow-growing toenails
- Pale feet when raised and dusky red feet when hanging down
How PAD can progress
For most people with claudication, PAD stays stable for years, especially when smoking stops and risk factors are controlled. In a smaller group it advances. The warning signs are pain in the foot or toes while resting, often at night and eased by hanging the leg over the side of the bed, and wounds on the toes or heel that do not heal. This stage, called chronic limb-threatening ischemia, means the foot is not getting enough blood even at rest. It needs prompt specialist care, because restoring flow is what allows wounds to heal and protects the limb.
PAD vs Vein Disease vs Spinal Stenosis
Leg pain with walking is not always arterial. Two common conditions that mimic PAD are venous insufficiency and narrowing of the spinal canal in the lower back. The differences matter because the treatments are completely different.
| Feature | Peripheral artery disease | Venous insufficiency | Spinal stenosis |
|---|---|---|---|
| Main symptom | Cramping in calf, thigh or buttock with walking | Aching, heaviness and swelling | Pain, numbness or weakness down the legs |
| Triggered by | A fairly predictable walking distance | Standing or sitting for long periods | Standing upright and walking |
| Relieved by | Stopping for a few minutes, even standing still | Raising the legs, compression | Sitting or bending forward |
| Skin changes | Cool, pale, shiny, hairless | Brown staining, swelling, varicose veins | Usually none |
| Key test | Ankle-brachial index, arterial ultrasound | Venous duplex ultrasound | MRI of the lumbar spine |
It is common to have more than one of these at the same time, particularly in older adults. A careful history and the right tests sort out which problem is causing which symptom. Compression stockings used for venous insufficiency, for example, should only be prescribed once significant arterial disease has been ruled out.
How PAD Is Diagnosed
The first test is the ankle-brachial index (ABI). Blood pressure cuffs are placed on the arms and ankles, and a small Doppler probe measures the pressure in each. In healthy legs, the ankle pressure is about the same as or slightly higher than the arm pressure. A lower ankle pressure means blood flow to the leg is reduced. The test takes about 15 to 20 minutes and is painless.
If the ABI is borderline, or if symptoms are typical but the resting ABI is normal, we may repeat the measurement after exercise. In people with diabetes or kidney disease, the leg arteries can be so stiff with calcium that the ankle cuff gives a falsely high reading; toe pressures help in that situation. An arterial duplex ultrasound then maps where the narrowing is and how severe it is. When a procedure is being planned, CT or catheter angiography shows the arteries in detail.
How We Evaluate Leg Circulation at Premier Vein
Our approach is to answer three questions: is this PAD, how severe is it, and what does it mean for your heart, legs and daily life?
- Focused history. We ask how far you can walk before pain starts, where you feel it, how long it takes to ease, and about smoking, diabetes, cholesterol, blood pressure, kidney disease, heart attack or stroke.
- Examination. We check pulses at the groin, knee and foot, inspect the skin, nails and any wounds, and compare the temperature and color of both feet.
- The right test. An ankle-brachial index in our accredited vascular lab, with arterial ultrasound when we need to locate the narrowing. If the veins may also be involved, a venous duplex ultrasound is added.
- A clear plan. We explain the findings, discuss risk factor control with you and your primary care doctor, and outline whether exercise and medicines are enough or whether a procedure would help.
PAD Treatment: Exercise, Medicines and Procedures
Supervised or structured walking
Walking is one of the most effective treatments for claudication. The usual approach is to walk until the pain becomes moderate, rest until it fades, and then walk again, for about 30 to 45 minutes several times a week. Over a few months, many people can walk noticeably farther, because the muscles adapt and small collateral arteries grow around the blockage.
Medicines that protect the arteries
Current guidelines recommend that most people with symptomatic PAD take an antiplatelet medicine and a statin, along with good control of blood pressure and blood sugar. These do more than help the legs; they lower the risk of heart attack and stroke. Your primary care doctor or cardiologist will usually manage these medicines alongside us.
Stopping smoking
Smoking is the strongest modifiable risk factor for PAD and for losing a limb to it. Stopping is difficult, and support from your doctor, medicines and counseling greatly improves the chances of success.
Minimally invasive procedures
When symptoms limit your work or daily life despite these measures, or when there is rest pain or a non-healing wound, the narrowed artery can often be reopened from the inside. Through a small needle puncture, an interventional radiologist uses balloon angioplasty, stents or atherectomy to restore flow. These are usually outpatient or short-stay procedures with no surgical incision, and most patients walk the same day. You can read more on our peripheral arterial disease treatment page.
Foot Care and Everyday Habits With PAD
Reduced circulation means small injuries heal slowly, so the feet need daily attention, especially if you have diabetes.
- Check both feet every day for cuts, blisters, color changes or sores
- Wear well-fitting shoes and clean, dry socks; avoid walking barefoot
- Have nails trimmed carefully, and see a podiatrist for corns or calluses
- Keep skin moisturized, but not between the toes
- Avoid heating pads or hot water on the feet, since reduced sensation can lead to burns
Call 911 or seek emergency care if you notice:
- A leg or foot that suddenly becomes cold, pale, painful, numb or weak
- Pain in the foot or toes at rest, especially at night, that is getting worse
- A wound on the foot that is turning black or shows spreading redness, fever or a foul smell
- Chest pain, sudden shortness of breath, face drooping or trouble speaking
When to See a PAD Specialist in Houston
If walking has become limited by leg pain, a foot wound is not healing, or your doctor has found weak pulses or a low ABI, it is worth having your circulation evaluated. Dr. Syed Raza, a fellowship-trained interventional radiologist and former Chief of Interventional Radiology at UTMB Galveston and Memorial Hermann Memorial City, has more than 15 years of experience treating PAD. Our vascular and vein clinic in Houston performs arterial testing in an IAC-accredited vascular lab, and same-week appointments are usually available for patients across Houston and Katy. Learn more about Dr. Raza or call (832) 321-5355.
Talk With a Specialist at Premier Vein
Have questions about your symptoms or treatment options? Dr. Syed Raza and the team at Premier Vein & Vascular Center can evaluate your concerns and explain your options clearly. Same-week appointments are usually available, and most insurance plans are accepted.
Frequently Asked Questions
What is the first sign of peripheral artery disease?
For many people, the first sign is cramping, aching or fatigue in the calf, thigh or buttock that comes on with walking and eases within a few minutes of rest. Others have no symptoms, and PAD is first found because of weak foot pulses or a low ankle-brachial index.
Can peripheral artery disease be reversed?
Plaque that has already formed does not usually disappear, but PAD can be controlled. Quitting smoking, regular walking and medicines such as statins can slow the disease and improve walking distance, and narrowed arteries can be reopened with angioplasty or stents when needed.
Is walking good for PAD?
Yes. A structured walking program, in which you walk until moderate pain, rest and repeat, is one of the most effective treatments for claudication. Over several months it often increases how far you can walk without pain.
What is a normal ankle-brachial index?
An ABI of roughly 1.0 to 1.4 is generally considered normal. A value of 0.90 or lower suggests PAD, and lower values indicate more severe narrowing. Very high values can mean the arteries are stiff with calcium and need other testing.
Is PAD the same as poor circulation from veins?
No. PAD affects the arteries that carry blood to the legs, while venous disease affects the veins that return blood to the heart. They cause different symptoms and need different treatments, and some people have both.
Who should be screened for PAD?
Screening is often recommended for adults over 65, and for younger adults with diabetes, a history of smoking, kidney disease or known heart or stroke disease. Anyone with leg pain on walking or a slow-healing foot wound should be checked.
Does PAD always need a stent?
No. Many people with PAD never need a procedure. Stents or angioplasty are generally considered when leg pain limits daily life despite exercise and medicines, or when there is rest pain or a non-healing wound.
Trusted Health Resources
- Peripheral Artery Disease, National Heart, Lung, and Blood Institute (NIH)
- Peripheral Arterial Disease, MedlinePlus (NIH)