PERIPHERAL ARTERIAL DISEASE
The arteries in your legs carry oxygen-rich blood to your muscles and feet. When they narrow, the blood supply falls short – causing pain on walking and, in severe cases, skin ulcers or gangrene.
Peripheral Arterial Disease
Peripheral arterial disease (PAD), also called leg artery disease, is a narrowing of the arteries that supply your legs. It is caused by plaque (cholesterol and calcium) building up in the artery walls and hardening them – a process called atherosclerosis. It becomes more common with age, especially after 70, and smoking and diabetes bring it on sooner.
As the arteries narrow, your legs get less blood and oxygen. This can cause pain on walking and, in severe cases, sores or gangrene.
PAD is also an important warning sign: the same plaque often affects the arteries to the heart and brain. So treating PAD matters not only to protect your legs, but to lower your risk of a heart attack or stroke.
Symptoms
Claudication
Many people have no symptoms at all. The most common symptom, when it occurs, is intermittent claudication – cramp, ache, heaviness or tiredness in the legs that comes on with walking and eases with rest. It often starts sooner uphill or on stairs, and over time after shorter distances.
Critical limb ischaemia
This is the advanced stage, where the leg is short of blood even at rest. It can cause pain in the feet or toes at rest, sores (ulcers) that will not heal, or gangrene (dead tissue), and needs prompt treatment.
Causes
PAD is caused by atherosclerosis. Your risk rises with age (especially over 50) and is higher in men. Other things that raise your risk:
Smoking
Diabetes
High blood pressure
High cholesterol
Being overweight
Tests
I begin by asking about your symptoms and health, and feeling the pulses in your legs and feet.
Ankle-brachial pressure index (ABPI)
Compares the blood pressure at your ankle with that in your arm; a lower ankle reading points to narrowed leg arteries.
Duplex ultrasound
A painless scan that shows blood flow and locates the blockages.
Other scans
Pulse-volume recordings, an MRA (magnetic resonance angiogram) or angiography (dye and x-rays) may be used to map the disease in detail, usually when planning a procedure. Blood tests check your cholesterol and other risk factors.
Treatment Options
Optimal Medical Therapy
A structured walking programme is the most effective non-surgical treatment: regular walking, ideally supervised, trains your legs to walk further with less pain. Stopping smoking is essential.
Medication protects your arteries: an antiplatelet (aspirin or clopidogrel) to lower clot risk, a statin for cholesterol, and treatment for your blood pressure and diabetes. A medicine such as cilostazol (or pentoxifylline) may modestly improve how far you can walk.
Endovascular
For more advanced disease, angioplasty and stenting may be advised. A thin tube (catheter) is passed from an artery in the groin or arm to the narrowed area, where a small balloon widens the artery. A small mesh tube (stent) may be left in place to hold it open. It is less invasive than open surgery, and blood then flows more freely.
Surgery
Endarterectomy
Through an incision in the leg, I remove the plaque from the lining of the artery, opening it up and restoring blood flow.
Bypass surgery
A graft – one of your own veins or a fabric tube – is used to route blood around the blocked section, creating a new path to your leg.
Amputation
This is a last resort, considered only when the circulation is too poor to restore and the tissue cannot be saved. Seen early by a vascular specialist, many people with gangrene can avoid a major amputation, or limit it to a small part of the foot or toes.
General Guidelines
Day-to-day steps that help control PAD and protect your heart and brain:
Stop smoking
Walk regularly – aim for at least 30 minutes, most days
Control diabetes, blood pressure and cholesterol
Eat a low-fat, healthy diet
Keep to a healthy weight
References
European Society for Vascular Surgery (ESVS) 2024 Clinical Practice Guidelines on Asymptomatic Lower Limb Peripheral Arterial Disease and Intermittent Claudication. Eur J Vasc Endovasc Surg, 2024.
Society for Vascular Surgery Clinical Practice Guideline on the Management of Intermittent Claudication: Focused Update. J Vasc Surg, 2025.
Our Services
Arterial
Procedures
Standard open arterial surgical procedures to repair or reconstruct blood flow to extremities.
Femoropopliteal bypass
Femoral endarterectomy
Femoropopliteal thrombectomy
Femorotibial bypass
Endovascular
Procedures
These less invasive procedures are the preferred technique and are often considered a first-line strategy.
Angioplasty with / or without stent of
Superficial femoral artery
Popliteal artery
Tibial arteries
Peripheral arterial catheter directed thrombolysis
Hybrid
Procedures
Combined endovascular and open surgical procedures are selectively utilised to repair or restore blood flow to the extremities.
Femoral endarterectomy with peripheral angioplasty
Femoropopliteal thrombectomy with peripheral angioplasty with /or without stent
If you have any problems with any of these conditions, please contact your General Practitioner, or your Vascular Surgeon. If you live in Pretoria and have not seen a Vascular Surgeon before, you are more than welcome to contact my rooms for a formal consultation.
Gregory Weir Vascular Surgery
The purpose of this web site is to offer Dr Weir’s patients and their families access to information regarding vascular disease in general as well as specific information on certain disease processes. The information on this site does not necessarily apply to all patients with the same diagnosis. If you are not a patient of Dr Weir, please do not regard the information on this website as a substitute for a thorough assessment by a qualified Vascular Surgeon. If in doubt, consult your doctor.
If you are experiencing a medical emergency, phone us. If you are not able to get through or if we are not available, please visit your nearest casualty department.
Consultation Rooms
Vascular & Hyperbaric Unit, Life Eugene Marais Hospital, Pretoria
Medically reviewed by Dr Gregory Weir, vascular surgeon. Last updated June 2026.