Arterial blockage

Peripheral arterial disease (PAD) means the arteries that carry blood to your legs have become narrowed or blocked. The cause is usually a build-up of fatty, hardened material in the artery wall, called atherosclerosis.

With less blood getting through, your leg muscles run short of oxygen when they work. The classic sign is a cramping pain in the calf, thigh or buttock when you walk, which eases within minutes of rest. This is called claudication.

PAD matters for two reasons. In some people the blood flow falls so low that the foot is at risk of wounds and gangrene. And the same process often affects the arteries of the heart and brain, so PAD is a warning sign for heart attack and stroke too.

The same things that damage the heart arteries damage the leg arteries. The most important are:

Smoking, which is the strongest single risk factor

Diabetes

High blood pressure

High cholesterol

Getting older

Kidney disease

A family history of heart or artery disease

The good news is that most of these can be controlled. Stopping smoking, good sugar control and the right medicines slow the disease down and protect the heart and brain as well as the legs.

The doctor asks how far you can walk before the pain starts, where you feel it and how quickly it settles. Your feet are checked for pulses, colour, temperature and any wounds.

Two simple, painless tests usually confirm the diagnosis in the same visit:

The ankle–brachial index, or ABI (a blood pressure comparison between ankle and arm). A result below 0.9 suggests narrowing.

A duplex Doppler scan of the leg arteries, which shows where the narrowing is and how severe it is.

In people with diabetes or kidney disease the arteries can be stiff, which makes the ABI less reliable, so the scan matters even more. If a procedure is being considered, a CT angiogram (a CT scan with dye) may be arranged to map the arteries in detail. Bring any previous scans and your list of medicines.

Treatment depends on how much the disease limits your life and whether the foot is at risk:

Risk-factor control: stopping smoking, controlling sugar, blood pressure and cholesterol. Most patients are advised to take an antiplatelet (a medicine that makes blood less sticky) and a statin.

A walking programme: regular walking to the point of pain, resting, then walking again. Over months this often increases the distance you can walk.

Balloon angioplasty: a fine wire and balloon are passed into the artery through a needle puncture, usually in the groin, and the balloon opens the narrowing.

Stenting: a small metal mesh tube is left in place to keep the artery open when a balloon alone is not enough.

Bypass surgery: a vein or synthetic tube is used to carry blood around a long blockage, for disease that cannot be treated from the inside.

Procedures usually take 60–120 minutes, with a short hospital stay.

After angioplasty or stenting most people go home the same day or the next morning. You will be asked to rest the leg for a few hours and to avoid heavy lifting for a few days while the puncture site heals. Walking is encouraged soon after.

Recovery after bypass surgery takes longer, usually several weeks, with wound care and a gradual return to activity.

Whatever the treatment, the medicines and lifestyle changes remain important for life. Arteries can narrow again over time, so follow-up visits with a Doppler scan are arranged to catch any problem early. Keep walking every day; it is one of the best things you can do for your circulation.

Book a visit if you get pain in the calf, thigh or buttock when walking that eases with rest, or if your feet are often cold, pale or have weak pulses.

See a doctor within days if you have:

Pain in the foot or toes at rest, especially at night, that eases when you hang the leg over the bed

A wound on the foot or toes that is not healing

A toe that is turning dark or black

Go to the emergency department straight away if:

Your leg or foot suddenly becomes cold, pale or blue, very painful, numb or weak. This can mean a sudden blockage, and treatment within hours can save the leg.