What is peripheral arterial disease?

Peripheral arterial disease (PAD) is a condition in which plaque builds up and causes narrowing in the arteries which supply circulation to the legs, arms, brain, kidneys or intestines. It generally occurs in the elderly and the risk of developing PAD is increased in smokers and those with a strong family history. Other risk factors include high blood pressure, diabetes and high cholesterol.

Peripheral arterial disease symptoms

The symptoms of PAD depend on which artery is narrowed down. The most commonly affected arteries are those that supply the circulation to the legs. Blockages in the leg arteries tend to present with pain on walking (claudication) which causes the individual to stop walking due to the pain they develop. As it progresses, this pain causes them to wake up in the middle of the night from a lack of circulation to their legs and even worse, can lead to ulcers and gangrene. Those who wait until they develop ulcers or gangrene have a much worse outcome even with treatment than those presenting in the early stages of PAD.

Peripheral arterial disease treatment

The initial treatment for all those with PAD is to minimise the risk factors (especially smoking), developing a healthy lifestyle and potentially medications to treat high cholesterol, high blood pressure and possible use of blood thinners to minimise progression of the plaque build-up. Fortunately, recent advances in technology allow most of the blocked arteries to be treated with angioplasty and stenting although surgical bypasses are occasionally necessary.

Dr Shakibaie has over 20 years of experience performing angioplasty and stenting and is one of his main areas of interest. He is highly trained in the use of angioplasty equipment and has succeeded many times in treating patients with angioplasty and stenting where some of his colleagues have recommended surgery.

What causes peripheral arterial disease?

Atherosclerosis, the build-up of fatty deposits in the arteries, is the primary cause of peripheral arterial disease. Peripheral arterial disease is common, between 10-15% of people are affected by it. 

The risk factors for peripheral arterial disease are risk factors that promote atherosclerosis to develop in the arteries.

These risk factors include:

  • Smoking
  • High blood pressure
  • High cholesterol
  • Type 2 diabetes
  • Older age (peripheral arterial disease is uncommon under the age of 50)

Peripheral arterial disease symptoms

The majority of people with peripheral arterial disease may not have any symptoms. For those who do have symptoms, these can include:

  • Intermittent claudication of the calf or buttock muscles (muscle pain or cramps in the calves or buttocks when walking or doing mild exercise)
  • Pain in the foot when sleeping at night time
  • Pulses that are weaker than usual
  • Painful ulcers as the PAD progresses

Examinations and investigations

Given that a large proportion of people who have peripheral arterial disease do not have symptoms, the diagnosis relies on careful history and examination by a doctor. The doctor will ask about any symptoms and perform an examination, which will include taking the pulse at different body sites. The first thing that a doctor will usually measure is ankle-brachial index, which is the ratio of the blood pressure at the ankle compared to the pressure in the arm.  The doctor might also use duplex ultrasound. This can help to clearly identify the sites where there is plaque build-up.

Peripheral arterial disease can prevent people from carrying out daily activities and it increases the risk of cardiovascular events such as stroke and heart attack. For these reasons, it is important to have it diagnosed and treated early.

There are a number of treatment options for peripheral arterial disease and the suitability of these depend on the severity of the disease and the symptoms that are being experienced. The goals surrounding the management of peripheral arterial disease should include reducing the occurrence and likelihood of heart attack and stroke, reducing symptoms and improving quality of life. Occasionally, treatment for PAD is performed to avoid amputation of the affected leg. Lifestyle changes and medicines are treatments that should be utilised by all patients with PAD and surgical options should be considered for patients with more severe PAD.

Lifestyle changes

Stopping smoking is especially important and has a range of benefits including improving survival and reducing the likelihood of a heart attack. Stopping smoking and becoming physically active improves the distance that people with PAD can walk without experiencing pain or cramping and can improve quality of life. These measures are not only important in tackling PAD, but are good for the heart and overall health in general.


Antiplatelet medications (such as aspirin and clopidogrel) can be used to thin the blood, which will reduce the risk of blood clots, stroke and heart attack. However, patients must be assessed for suitability in order to address the risk of bleeding complications.

Medications for lowering cholesterol (statins) and medications to lower blood pressure (antihypertensives) may also be used to reduce rates of heart attack and stroke.  


Surgery should be considered for people who are having problems with symptoms. People whose symptoms interfere with their ability to work or carry out daily tasks and those with pain when resting or with ulcers will usually require surgery.  

The two most common options for surgery include endovascular angioplasty and stenting and open surgery.

Angioplasty and stenting

In this procedure a needle is inserted into the artery and a dye is injected. This allows the blocked area of the artery to be visualised with sophisticated X-ray equipment. The artery is then unblocked by inserting a small tube with a balloon into the blocked area and then inflating it. To keep the artery open, a stent (a small tube) is sometimes placed in the artery. This allows blood to freely flow through the artery. Usually, angioplasty and stenting only requires a local anaesthetic and no surgical incisions. This means that patients can usually return home the same or next day after angioplasty. 

Bypass surgery

Bypass surgery is an alternative to angioplasty and may occasionally be performed if the blockage is not suitable for angioplasty. It involves using a vein from the leg or an artificial vein and attaching it to the affected artery. The vein is sutured around the blockage, so blood flow is now directed through the vein and back to artery, effectively bypassing the blockage. Bypass surgery is a more invasive procedure and is usually performed under general anaesthetic. For these reasons, the individual often needs to stay in hospital for approximately one week after surgery.

Before the procedure

  • There is no need to fast before the angioplasty unless you are having sedation by an anaesthetist (in which case you will need to fast for 4-6 hours)
  • Take all your regular medications unless otherwise instructed (e.g. may need to stop certain types of blood-thinners)
  • Please remain well hydrated before the procedure and drink plenty of water.
  • If you feel nervous just prior to the procedure, please advise the nursing staff and Dr Shakibaie will prescribe a mild sedative if required.

After the procedure

After receiving treatment for peripheral arterial disease, there are steps that you should take to maximise your recovery and make sure that the treatment works as well as it possibly can.

  • You will have pressure applied to the needle puncture site (usually the groin) for 10-20 minutes. After this you will have to lay flat on the bed for 2-3 hours before you can get up and walk. If you find lying flat difficult due to back or hip problems, please advise Dr Shakibaie or the nursing staff.
  • You will be discharged home either on the same day as the procedure or the next day. This would have been discussed with you during your initial consultation. If your plans have changed, please advise the nursing staff as soon as you can.
  • If you are staying overnight, you may have an ultrasound performed on you prior to being discharged home.
  • You are not to drive on the same day as the procedure (even if you are discharged on the same day). Driving is permitted the next day as long as you feel it is safe to do so. Please use your common sense to make this decision.
  • There will always be some bruising around the needle puncture site which may take a few days to a couple of weeks to resolve. Sometimes the bruising can be quite extensive but should not significantly limit your mobility. If it does, please advise Dr Shakibaie or the nursing staff.

After hospital discharge and follow-up

  • Please only perform light activities for 2 days post procedure.
  • An ultrasound will be arranged for a few weeks after your discharge followed by a follow-up appointment. If you have not heard from us within two weeks of discharge, please contact Dr Shakibaie’s office on 9310 2300.