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Peripheral arterial disease (PAD)

Sydney Vascular Surgeon - Dr Mayo Theivendran

What is peripheral arterial disease (PAD)?

A common condition that usually starts with leg pain

You are probably familiar with the terms angina and heart attack, which are related to a blockage of blood flow to the heart. The same sort of blockage can occur elsewhere in the body, depriving the limbs (the peripheral parts of the body and organs) of blood flow. If left untreated, PAD can lead to amputation or organ dysfunction.

Healthy peripheral arteries are smooth and unobstructed, allowing blood to flow freely to provide the legs with oxygen, glucose and other nutrients. As we age, peripheral arteries build up plaque, a sticky substance made up mostly of fat and cholesterol. Plaque narrows the passageway within the arteries and causes them to become stiff.

A moderate blockage in one of the arteries in a major leg muscle, such as the calf or thigh can cause pain when walking. This pain may ease with rest; however it will increase again with more walking or activity. Lower extremity pain, similar to angina is called claudication by medical practitioners. The pain itself is not limb-threatening but is a sign that the person should make lifestyle changes and see a vascular surgeon.

PAD affects up to 20% of Australians over 75 years of age and is more common in men.

PAD affects up to 20% of Australians over 75 years of age and is more common in men.
PAD treatment Sydney

What causes PAD?

The main cause of PAD is the build-up of fatty deposits inside your arteries called ‘atherosclerosis’. Other things that can make it more likely for you to develop PAD include:


Smoking is a major risk factor for PAD because the harmful chemicals in cigarettes can damage your blood vessels.


Diabetes results in high blood sugar levels which can harm your blood vessels and increase your risk of PAD.

High blood pressure

If you have uncontrolled high blood pressure, it can damage your arteries and make PAD more likely.

High cholesterol

The fatty deposits that build up in your arteries contain cholesterol. Having high levels of cholesterol in your blood can contribute to the development of PAD.

High homocysteine

Homocysteine is an amino acid found in the bloodstream. A blood test showing a high level of homocysteine is a risk factor for PAD.


PAD is more common in people who are aged 50 or older because the risk of fat build-up in the arteries increases with age.

Family history

If other people in your family have had PAD, you may be more likely to develop it too.


Being overweight can put extra pressure on your blood vessels, increasing your risk of PAD.

What are the symptoms of peripheral artery disease?

PAD can develop slowly, and you may not notice any symptoms at first. But as it progresses, you might experience:

PAD causes leg pain when walking

Leg pain when walking

Leg pain is one of the main symptoms of PAD. You may feel cramps, or aches in your legs when you walk or exercise. This pain typically goes away when you rest, which makes it different from pain caused by other conditions.

PAd causes skin changes

Skin changes

PAD can affect your skin. You may notice:

  • Pale or bluish-looking skin on your legs
  • Legs that feel cool or cold to the touch
  • Less hair on your legs
  • Sores or wounds on your feet that take a long time to heal.

PAD cuases resting leg pain

Resting leg pain

In more advanced PAD, you might have pain in your legs even when you're not moving. This pain can be severe and may disturb your sleep.

Ulcers and gangrene from peripheral arterial disease

How is PAD diagnosed?

Early diagnosis of PAD is essential for effective management. Your doctor may use various methods to diagnose the condition, including:

Ankle brachial pressure index (ABPI)

The ankle brachial pressure index (ABPI) is a simple and painless test that compares the blood pressure in your arms and ankles. Measuring ankle brachial pressure helps your doctor assess how well blood is flowing to your legs. A lower ABPI value indicates more blockage in your leg arteries.

Duplex ultrasound

Duplex ultrasound combines traditional ultrasound with Doppler technology to create clear images of how blood is flowing within your arteries. It helps your doctor precisely pinpoint blockages or obstructions.


Angiography is a more invasive procedure that involves injecting a special dye into your arteries and then taking X-ray images. It provides detailed information about the location and severity of arterial blockages.

Magnetic resonance angiography and computed tomography

These are advanced techniques that provide clear images of your blood vessels, helping your doctor diagnose and assess the extent of PAD.

What are the complications of PAD?

If left untreated, PAD can lead to serious complications, including:

Critical limb ischaemia is a complication of untreated PAD

Critical limb ischaemia

Critical limb ischaemia is an advanced stage of PAD where severe blockages restrict blood flow to your legs. It can result in tissue damage, ulcers, and even gangrene.

In severe cases, amputation of the affected leg may be necessary.

Cardiovascular complications is a complication of untreated PAD

Cardiovascular complications

PAD doesn't only affect your legs. It also increases your risk of heart attack and stroke because the same fatty build-up that occurs in your leg arteries can happen in your heart and neck arteries as well.

Reduced quality of life  is a complication of untreated PAD

Reduced quality of life

The symptoms of PAD, especially leg pain, can greatly limit your mobility and quality of life. Everyday activities and exercise become more challenging, leading to a more sedentary lifestyle, which can contribute to other health problems.

How is PAD treated?

Effective PAD treatment aims to reduce symptoms, improve blood flow, and lower the risk of complications. The PAD treatment your doctor recommends will depend on the severity of your condition, what treatments you’ve already tried and your individual health factors.

Lifestyle changes

For mild PAD, treatment involves making lifestyle changes to manage the condition. These changes can include:

Aneurysmal disease - age risk factor

Quitting smoking: Stopping smoking is crucial to improve blood flow.

Aneurysmal disease - gender risk factor

Exercise: A structured exercise program, such as walking, can help improve your symptoms and increase your ability to walk without pain.

Aneurysmal disease - atherosclerosis risk factor

Weight management: Maintaining a healthy weight can reduce the strain on your blood vessels.

Aneurysmal disease - family history risk factor

A healthy diet: Eating a heart-healthy diet that's low in saturated fats and cholesterol can help manage risk factors like high blood pressure and high cholesterol.


Your doctor may prescribe medications for PAD and its related risk factors:

  • Antiplatelet medications: These medications thin your blood, helping to prevent blood clots.
  • Statins: These medications help lower cholesterol levels in your blood.
  • Blood pressure medications: Angiotensin-converting enzyme (ACE) inhibitors, or angiotensin receptor blockers (ARBs), can help control high blood pressure and also reduce the risk of PAD.
Revascularisation procedures

For more severe cases of PAD, your doctor may recommend a revascularisation procedure to improve blood flow. These procedures include:

Balloon angioplasty

This is a minimally invasive (endovascular) PAD treatment. Dr Theivendran uses a balloon to widen the narrowed artery. He may then scrape away the plaque blocking the artery using an instrument on the end of a tube.

This is often followed by the placement of a stent to keep the artery open.

Read more about angioplasty

Balloon angioplasty is used in the treatment of peripheral arterial disease.

Open surgery for PAD

When a large blood vessel, such as the one in your thigh is affected, Dr Theivendran can remove the fatty deposits with an open surgical procedure called ‘endarterectomy’.

Alternatively, he may bypass the blocked artery using a healthy blood vessel from another part of your body.

Read more about open surgery for PAD

Open bypass surgery is used in the treatment of peripheral arterial disease.

Hybrid surgery for PAD

Sometimes the best course of action is a combination of procedures where some problem areas are treated with minimally invasive (endovascular) surgery and other areas require open surgery.

  How Dr Theivendran can help

If peripheral artery disease is affecting your quality of life and non-surgical treatments haven’t worked, ask your treating doctor for a referral to Dr Theivendran an experienced Vascular and Endovascular surgeon.

He will assess your condition and, if appropriate, discuss surgical options that can bring you lasting pain relief and peace of mind.

If you have any questions, please don't hesitate to contact our rooms on (02) 9066 6547

For appointments and enquiries:

Monday - Friday: 8:00am to 5:00pm
Fax: (02) 9182 7533

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