​Peripheral Artery Disease​

Peripheral artery disease or peripheral arterial disease (PAD) is a disease affecting the blood vessels supplying blood to various body parts except heart. It most often affects the arms and legs. It is caused by build-up of a hardened substance known as plaque in the arteries that carry blood to your limbs, head, kidneys and other organs. Plaque is made up of fat, cholesterol, calcium or other tissues and causes the arteries to become narrow; subsequently your organs do not receive enough blood and therefore oxygen, which is vital for the body to function. Build-up of plaque in the body's arteries is known as atherosclerosis.

Blockage of blood flow causes pain and numbness in the affected areas. In severe cases, the affected area may face tissue death (known as gangrene) and can lead to amputation. Factors contributing to high risk of PAD include:

  • Diabetes

  • Heart diseases

  • Kidney diseases

  • High blood pressure

  • Smoking

  • High levels of cholesterol

  • Stroke

Peripheral arterial disease affects both men and women, although the incidence is slightly higher in men. Age, weight and lifestyle factors also contribute to the likelihood of contracting PAD. Having PAD also increases your risk of contracting heart disease, having a stroke or getting an infection.​

The most common symptoms of peripheral arterial disease are:

  • Leg pain, that occurs when you are in motion and stops when you are at rest. This is caused by higher demand for blood oxygen than the body can provide. This is usually a severe pain, accompanied by cramps and/or a feeling of heaviness or tightness in the muscles that makes you stop for a while.

  • Feeling of numbness or tingling in the legs

  • Cold sensation experienced in the legs or feet 

  • Fatigue

  • Change in the pallor of skin

  • A wound that does not seem to heal

  • Impotence

  • Loss of hair on the legs

  • Slower growth of toenails

  • Painful cramps experienced in the hip, thigh and/or calf muscles​

Usually the symptoms of peripheral arterial disease worsen due to physical activity and recede when you are at rest. If you are experiencing any of the symptoms mentioned above, it is recommended that you consult a physician in the <Heart, Lungs and Vascular Service Line> at The Aga Khan University Hospital immediately, especially if you fall in the high risk group due to age or lifestyle factors such as weight and smoking. These symptoms are common to several diseases so they can sometimes be missed or ignored. Do not ignore your symptoms and consult a doctor immediately as the disease is more easily treatable at early stages. At advanced stages it may lead to severe consequences such as amputation of the affected limb, heart attack or stroke. The <Heart, Lungs and Vascular Service Line> at The Aga Khan University Hospital offers multidisciplinary care under one roof and has an internationally accredited program along with highly trained staff. 

Your time with your doctor maybe limited, so makes sure to prepare for your visit beforehand. Here are some tips to help get you started.

As mentioned above, it is important to diagnose the symptoms of peripheral arterial disease as early as possible in order to begin treatment, as the disease may become life threatening if left untreated for too long. The first step in diagnosis is a complete medical history and a physical exam, including listening to your pulse with a stethoscope and Doppler probe. There are several other tests used in conjunction with this, which include:

  • Doppler ultrasound: In this procedure, high frequency sound waves are used to create images of your body. It is a non-invasive and painless procedure. Your doctor will check the blood flow in your vessels for abnormalities. 

  • ABI (Ankle-Brachial Index): This is one of the most common tests used to diagnose PAD. Your doctor will attach cuffs to your hand and feet and compare the blood pressure in your ankle to the blood pressure in your arm. This test can also be coupled with an exercise test to measure your blood pressure before and after exercise, to determine whether the arteries are narrowed and how they are affected by physical strain. 

  • Blood tests: Your doctor will want to check for diseases such as high cholesterol and diabetes, which are contributing factors to peripheral arterial disease.

  • Angiography: In this procedure, your doctor will insert a device known as catheter into your arteries. A contrasting dye is injected so that an X-ray image can be captured for further analysis. This device can also be used to widen up the arteries if needed.

  • MRI (Magnetic Resonance Imaging): A machine with a magnetic field is used to capture images of your insides. These are non-invasive and painless procedures, and preferred to invasive procedures such as angiography. ​

It is vital to receive prompt treatment for peripheral arterial disease. Lifestyle changes go a long way to ease the symptoms and prevent future complications. This includes quitting smoking, losing weight, adopting a healthy diet and initiating a regular exercise program. Another option for treatment is the use of medication to ease the pain and restore regular blood flow. This includes:

  • Medication such as Cilostazol or pentoxifyllineto increase blood flow and ease pain in the limbs 

  • Medication such as clopidogrel or aspirin to reduce risk of blood clots

  • Medication to lower cholesterol

  • ACE (Angiotensin-converting enzyme) inhibitors to lower blood pressure

  • Diabetes medication to control blood sugar

Another option for treatment is invasive methods such as angioplasty, in which a long tube is inserted into the blocked artery, and a balloon attached to the tip is used to widen the narrowed artery. Vascular surgery can also be performed, using a technique known as bypass. The narrowed artery is ignored and blood flow is restored by connecting the affected area with another vein (a healthy, unaffected one) from a different part of your body. 

The Aga Khan University Hospital offers various support services to help with managing or recovering from the disease or condition. These include but are not limited to nutrition, physiotherapy, rehabilitation, specialized clinics and some patient support groups. Your doctor or nurse will advise you accordingly.

The Aga Khan University Hospital offers financial assistance to those who are in need and fulfil the eligibility criteria. For further information, you can contact the Patient Welfare Department. You can find the contact number of the Patient Welfare Department in the 'Important Numbers' section on the website homepage.

The financial counselling staff is available during office hours, at the main PBSD (Patient Business Services Department), to answer your financial queries on treatments' costs and authorize admissions on partial deposit as per hospital policies allow. The financial counsellor in the emergency room is open 24/7. You can find the contact number of the Patient Business Services in the 'Important Numbers' section on the website homepage.

Your doctor and or nurse will give you specific instructions about the prescribed medication. Please ensure that you take or use the prescribed medicine as advised. It can be dangerous to your health if you self-prescribe. Please inform the doctor or nurse beforehand if you have experienced any adverse reactions to any medications in the past. If you experience any symptoms of drug poisoning, overdose or severe reaction please contact the Pharmacy Service at The Aga Khan University Hospital immediately. You can find the contact number of the Pharmacy Services in the 'Important Numbers' section on the website homepage.

​​The information provided on our website is for educational purposes and not intended to be a substitute for medical advice, diagnosis or treatment. You should always seek the advice of your doctor or other healthcare professional provider.