Peripheral Artery Disease: The Circulation Problem Most People Don't Know They Have

What Is Peripheral Artery Disease?

Peripheral artery disease — PAD — occurs when the arteries supplying blood to the legs narrow due to atherosclerosis. Plaque gradually builds up inside the artery walls, reducing the diameter of the vessel and restricting blood flow to the muscles and tissues of the lower extremities.

In mild cases, the reduced flow is only noticeable during exertion — when muscles demand more oxygen than the narrowed arteries can supply. This produces a characteristic symptom called intermittent claudication — cramping or aching pain in the calf, thigh, or buttock that comes on with walking and resolves with rest. In more severe cases, the restriction is enough to cause pain at rest. In the most severe cases, critical limb ischemia develops — insufficient blood flow even at rest, leading to tissue death and the risk of amputation.

Why PAD Is About More Than Your Legs

PAD is not just a problem for your legs. It is a marker of systemic atherosclerosis — the same disease process affecting arteries throughout the body. People with PAD have dramatically elevated risk of heart attack and stroke. The five-year mortality rate for people with symptomatic PAD is approximately 30% — comparable to many cancers — largely because of associated coronary and cerebrovascular disease.

This means that identifying PAD has implications beyond the legs. It tells you and your physician that atherosclerosis is present and systemically active — triggering evaluation and treatment of cardiovascular risk factors that protect the heart and brain as much as the limbs.

The Silent Majority

The most important thing to understand about PAD is that most people who have it do not have the classic symptom of calf pain with walking. Studies consistently show that fewer than 20% of PAD patients have typical claudication. The majority have atypical symptoms — leg fatigue, weakness, or aching that they attribute to aging or other causes — or no symptoms at all.

This means that symptom screening alone will miss the vast majority of PAD. The only way to reliably identify PAD in its early stages — when intervention is most effective — is through vascular imaging.

What a Lower Extremity Arterial Ultrasound Shows

A lower extremity arterial duplex ultrasound maps blood flow through the major arteries from the groin to the foot. Using Doppler technology, the sonographer measures flow velocities at multiple points along each artery — identifying locations where flow is abnormally elevated (indicating stenosis) or absent (indicating occlusion).

The study can precisely locate and grade the severity of disease at each arterial segment — information that is essential for any treatment planning. It can differentiate between mild disease that warrants medical management and monitoring, and severe disease that may benefit from intervention. And it can establish a baseline for tracking progression over time.

For people with diabetes, smoking history, high blood pressure, or a family history of vascular disease — particularly those over 50 — a lower extremity arterial ultrasound is one of the most valuable preventive studies available.

No referral needed. Results from a board-certified cardiologist in 24–48 hours.