PERIPHERAL ARTERIAL DISEASE

Peripheral Arterial Disease (PAD): Narrowed Arteries and Poor Circulation Surgery and Treatment in Singapore

Background

Peripheral arterial disease (PAD) refers to the narrowing or blockage of arteries outside of the heart and brain, most commonly in the legs. It is usually caused by atherosclerosis, where fatty deposits (plaques) build up inside the artery walls.

This narrowing reduces blood flow to the muscles and tissues, leading to symptoms such as leg pain when walking. PAD is part of the same spectrum of disease as heart attack and stroke, and its presence is a strong warning sign of more widespread cardiovascular disease.

Symptoms of PAD

Not everyone with PAD will have symptoms, but when present they may include:

  • Pain, cramping or heaviness in the legs when walking (claudication)

  • Pain in the feet or toes at rest, especially at night (rest pain)

  • Non-healing wounds or ulcers on the feet

  • Cold or pale feet and legs

  • In severe cases, tissue death (gangrene)

Many patients dismiss leg pain as “old age” or “slowing down,” but persistent pain on exertion is often due to PAD and should be assessed by a vascular surgeon.

Risk Factors for PAD

The same factors that cause coronary artery disease can lead to PAD. These include:

  • Smoking

  • Diabetes

  • High blood pressure

  • High cholesterol

  • Family history of vascular disease

  • Increasing age

Complications of PAD

If left untreated, PAD can progress to critical limb ischaemia (CLI) — severe obstruction of blood flow to the legs and feet. This may cause constant pain, ulcers, or gangrene, and in some cases, can lead to limb loss (amputation).

Importantly, PAD is not just a leg problem. Patients with PAD are at higher risk of heart attack and stroke.

Diagnosis of PAD

Diagnosis usually involves:

  • Ankle-Brachial Index (ABI): A simple test comparing blood pressure in the ankle and arm

  • Duplex ultrasound: Imaging to assess blood flow and narrowing

  • CT angiography or MR angiography: Detailed imaging of the arteries

  • Digital subtraction angiography (DSA): Invasive imaging sometimes combined with treatment

Treatment Options for PAD

Treatment depends on the severity of disease and symptoms:

  • Lifestyle and risk factor management: Stop smoking, exercise programmes, weight loss, diabetes and blood pressure control.

  • Medication: To improve circulation, thin the blood, and reduce cardiovascular risk.

  • Endovascular (minimally invasive) treatments: Angioplasty, stenting, atherectomy.

  • Surgical bypass: Using vein or synthetic grafts to reroute blood around blockages.

  • Hybrid procedures: Combining minimally invasive and open surgery where appropriate.

The goal is not only to relieve symptoms but also to prevent cardiovascular events and preserve limb function.

Summary

Peripheral arterial disease is common but often underdiagnosed. It can significantly impact quality of life and may threaten limb survival if left untreated. Early recognition and treatment, combined with lifestyle changes and modern vascular interventions, can restore circulation, improve walking distance, and prevent major complications.

As a vascular and endovascular surgeon in Singapore, I offer comprehensive care for PAD, from early diagnosis to advanced treatment including minimally invasive angioplasty and surgical bypass.

Frequently Asked Questions (FAQ) about Peripheral Arterial Disease

What causes peripheral arterial disease?

PAD is caused by atherosclerosis — the build-up of cholesterol, fat and calcium inside artery walls. This narrows the arteries and reduces blood flow to the legs.

Is PAD the same as poor circulation?

Yes, PAD is the most common cause of poor circulation in the legs. However, not all circulation problems are due to PAD — other conditions, including venous disease and neuropathy, can cause similar symptoms.

What are the early signs of PAD?

The most common early symptom is cramping or pain in the calves, thighs or buttocks when walking, which improves with rest. This is called claudication.

How is PAD treated without surgery?

Lifestyle changes (especially quitting smoking and regular exercise) and medications can slow progression and reduce symptoms. Not all PAD requires surgery.

When is surgery or angioplasty needed?

Intervention is considered if you have severe claudication that limits daily life, rest pain, non-healing ulcers, or signs of critical limb ischaemia.

Can PAD be cured?

PAD cannot be “cured,” but with proper treatment it can be controlled. Procedures like angioplasty or bypass restore blood flow, while lifestyle and medical therapy reduce the risk of progression and complications.

How can I reduce my risk of PAD?

Stop smoking, maintain a healthy weight, control diabetes and blood pressure, exercise regularly, and take prescribed medication to manage cholesterol and prevent clotting.