Peripheral Artery Disease
A comprehensive guide

Peripheral Artery Disease treatment and awareness at RIVEA Vascular Care

Peripheral Artery Disease (PAD) is a progressive vascular condition characterized by the narrowing or blockage of arteries, most commonly in the legs, due to the buildup of plaque. This reduced blood flow can result in chronic leg pain, fatigue, non-healing wounds, and in severe cases, limb loss. Beyond its physical effects, PAD significantly compromises mobility and overall quality of life.

Why choose minimally invasive therapies for PAD over surgery?

Minimally invasive endovascular procedures have emerged as the gold standard in the treatment of PAD. Compared to traditional open surgery, these techniques offer equivalent—if not superior—clinical outcomes with fewer complications, quicker recovery, and less patient discomfort.

Open surgical procedures typically involve large incisions, general anesthesia, and extended hospitalization. In contrast, endovascular treatments are performed using small punctures and advanced imaging guidance, often under local anesthesia, allowing for a faster return to normal activities and fewer perioperative risks.

Common minimally invasive treatments for PAD:

  • Angioplasty: A catheter with a balloon tip is navigated to the narrowed artery and inflated to widen the vessel, improving blood flow.
  • Stenting: Often used in conjunction with angioplasty, a metal mesh tube (stent) is placed in the artery to keep it open and prevent re-narrowing.
  • Atherectomy: A device with a rotating blade or laser is used to remove plaque buildup from the arterial walls, restoring optimal blood flow.

These procedures are typically performed in outpatient settings and require minimal downtime.

Key advantages of minimally invasive PAD treatments

1. Reduced recovery time
 Patients undergoing endovascular therapy often resume regular activities within days. This is a stark contrast to the weeks-long recovery associated with open surgery.

2. Lower risk of complications
Minimally invasive techniques carry a significantly lower risk of infection, bleeding, and anesthesia-related complications. This is particularly advantageous for elderly patients and those with comorbid conditions.

3. Less pain and discomfort With minimal tissue disruption and smaller incisions, patients experience less postoperative pain and require fewer pain medications.

4. Improved long-term outcomes
Modern studies show that angioplasty, particularly when combined with drug-coated balloons (DCBs) or drug-eluting stents (DES), can provide long-term patency rates of up to 88%, reducing the need for repeat interventions.

5. Enhanced quality of life
Patients report a significant reduction in leg pain and fatigue, improved walking ability, and greater independence following endovascular interventions.

Benefit Minimally Invasive Treatments Traditional Surgery
Recovery Time Return to normal activities in 2–7 days Outpatient or short hospital stay (often < 24 hrs) Recovery can take 3–6 weeks Longer hospital stays often required
Risk of Complications Low risk of infection, bleeding, or anesthesia-related issues Local anesthesia used in most cases Higher risk of wound infections, blood clots, general anesthesia complications
Pain & Discomfort Minimal post-op pain
Small incisions or catheter entry pointsLower need for pain medication		 Significant post-op pain
Larger incisionsLonger pain management needed
Clinical Outcomes Comparable or superior long-term patency
Precise targeting of arterial blockagesHigh success with DCBs and stents (up to 88%)		 Effective but more invasive
Bypass grafts have good long-term results but higher early complication rates
Quality of Life Rapid return to mobility
Less fatigue and painImproved ability to walk and perform daily tasks		 Slower return to normal activity More fatigue, longer rehabilitation needed

When is angioplasty needed for leg pain?

Angioplasty may be appropriate for individuals experiencing symptoms such as:

1. Persistent fatigue and weakness: Not to be confused with ordinary tiredness, fatigue associated with PAD presents as a persistent, unexplained exhaustion and muscle weakness, even after rest or a healthy lifestyle. This fatigue can make basic activities like walking or standing difficult, as the leg muscles may no longer receive adequate oxygen-rich blood.

2. Leg or arm pain (claudication): PAD often causes cramping, aching, or heaviness in the legs or arms during physical activity, which subsides with rest. This discomfort, known as intermittent claudication, may become progressively more frequent or severe if untreated. Persistent, worsening pain could be a sign of critical limb ischemia and warrants immediate medical attention.

3.Skin discoloration: Poor circulation may cause the fingers or toes to appear blue, grey, or mottled. A purplish, lacy pattern or cold sensation in the limbs may indicate a severe reduction in blood flow. In extreme cases, small cholesterol emboli may block blood vessels, causing skin changes or sores that don’t heal.

Diagnostic tests for PAD

To confirm PAD and determine its severity, your physician may recommend the following diagnostic tests:

Blood tests: To check for elevated cholesterol, diabetes, or inflammation.

Ankle-Brachial Index (ABI): A comparison of blood pressure in the ankle and arm to evaluate blood flow. This may be done before and after exercise.

Doppler Ultrasound: Uses sound waves to detect blood flow in the legs and pinpoint blockages.

Angiography: Involves injecting contrast dye into the bloodstream and taking X-ray or CT/MRI images to locate narrowing or blocked arteries.

Angioplasty and Stent Placement

If PAD-related narrowing is identified, angioplasty with or without stenting may be performed. A catheter-mounted balloon is inserted into the narrowed artery and inflated to widen the vessel. In many cases, a stent—a small, wire mesh tube—is inserted to keep the artery open and maintain improved blood flow.

This intervention restores circulation, relieves symptoms, and helps prevent the progression to more severe complications like critical limb ischemia or limb loss.

Can I prevent amputations?

Yes. The most severe form of PAD, Chronic Limb-Threatening Ischemia (CLTI), poses a high risk of limb loss. For patients with below-the-knee (BTK) arterial disease, early intervention is essential. Endovascular revascularization, particularly using DCBs and DES, has become the standard of care due to high procedural success rates (~96–99%) and improved vessel patency.

These limb salvage interventions significantly reduce the need for amputation, especially when combined with wound care, infection control, and risk factor management.

What does PAD treatment feel like?

Angioplasty and stenting procedure overview:

  • You’ll be awake but sedated.
  • A local anesthetic is used to numb the insertion site (groin or arm).
  • A catheter is inserted into the artery and guided to the blockage.
  • Contrast dye is injected to visualize the blockage using fluoroscopy.
  • The balloon is inflated to open the artery, and a stent may be placed to maintain patency.
  • Afterward, the catheter is removed and pressure applied to prevent bleeding.
  • The procedure typically lasts 30 minutes to two hours, followed by a brief hospital stay.

What follow-up is needed after endovascular procedure?

Ongoing follow-up is critical to ensure the success of endovascular treatment and prevent recurrence.

1. Clinical assessment:
Regular evaluations of foot pulses and skin condition.
Monitoring for symptoms such as recurrence of leg pain or fatigue.

2. Imaging and testing:

  • Duplex Ultrasound (DUS): Checks for vessel patency.
  • Ankle-Brachial Index (ABI): Monitors changes in blood flow.
  • CTA or MRA: Used if restenosis is suspected.

3. Follow-up timeline:
Initial ABI to establish a post-treatment baseline.
Follow-up visits at 3-6 months, then annually.

4. Risk factor modification:
Control of blood pressure, cholesterol, and diabetes.
Quitting smoking
Daily walking or supervised exercise programs.

5. Individualized monitoring:
Patients with complex disease or prior restenosis may need more frequent evaluations and advanced imaging.

RIVEA Vascular Institute for advanced PAD care

At RIVEA, our commitment to cutting-edge vascular care ensures that every patient receives a personalized treatment plan. Our vascular team is led by American-board certified vascular specialist, Dr. Karthik Mikkineni. We utilize the latest minimally invasive techniques to restore circulation, preserve limbs, and improve quality of life.

RIVEA can help you with comprehensive PAD care, whether it’s managing early symptoms or treating advanced complications. We are Hyderabad’s premier centre for advanced vascular care.