It’s a condition as dangerous as a heart attack, yet few people talk about it. Peripheral artery disease (PAD) affects nearly 10% of Americans over 40, silently narrowing arteries and reducing blood flow to their legs. Despite its severity and high risk of death, PAD remains underdiagnosed and undertreated, often mistaken for aging or arthritis. Its symptoms are hiding in plain sight, and limbs or lives are at stake.
When Nadia Khan, MD, an interventional radiologist at UT Physicians Interventional Radiology Clinic, treats patients with PAD, she often wishes she could have met them years earlier.
“Due to the lack of awareness of the disease and its symptoms, a lot of our patients unfortunately present very late with non-healing wounds and severe symptoms, risking limb loss and amputation,” said Khan, assistant professor of radiology at McGovern Medical School at UTHealth Houston. “Think of it as a heart attack of your leg. It really is the same thing, but it’s just in a different location.”
The invisible enemy
What makes PAD particularly dangerous is its silent nature. People don’t realize what’s happening inside their bodies. The statistics are sobering. Studies show that major limb amputation increases a patient’s risk of death by 20% to 40%. For communities in the south, especially South Texas, the situation is even more critical. Khan said that’s the area with one of the highest amputation rates.
“It’s very unfortunate, because if we recognize these patients, we can connect them with vascular specialists,” Khan said.
PAD is a risk marker for coronary artery disease, cerebrovascular disease, diabetes, and hypertension.
Who’s at risk and warning signs
Three groups face the highest risk: people with diabetes, high blood pressure, and who smoke. The disease typically appears after age 50. Khan said smoking plays a particularly destructive role by hardening the vessel wall. Calcification and hardening translate to plaque, which leads to inflammation and narrowing of the blood vessels.
Symptoms can easily be mistaken for normal aging:
- Leg pain when walking
- Cramping and fatigue in hips, thighs, and calves
- Wounds in legs, feet, and toes that won’t heal
- Coldness in one leg
- Skin and hair changes in legs and nail changes in feet
Patients might mention experiencing pain when walking, and Khan said they’re unsure if it relates to their herniated disc or peripheral artery disease. The key difference is PAD doesn’t change with position like back pain does. It occurs during activity and improves with rest.
Detecting and treating PAD
The good news is that PAD can be detected with an ankle-brachial index (ABI), a quick, non-invasive test that compares blood pressure in the ankle to blood pressure in the arm. Khan said ABI helps define severity of the disease and helps screen for significant disease. An ABI result of 0.9 or higher is normal, while the lower the index, the more advanced the disease.
Fortunately, PAD can be managed through lifestyle changes and medical intervention when caught early. Khan’s recommendations are straightforward: quit smoking, control diabetes, exercise regularly, and manage blood pressure. She said even 30 minutes of exercise three to four times a week can make a difference.
“The body has a remarkable ability to adapt when blood flow is blocked, especially in conditions like peripheral artery disease,” Khan said. “In order to encourage better blood flow, you have to walk and be active.”
Khan said there are advanced endovascular (non-surgical) and surgical treatment options that help restore blood flow.
Breaking the silence
Perhaps the biggest challenge is awareness. Khan believes doctors should discuss PAD screening as routinely as heart disease. She recently treated a patient who came in too late. After experiencing long-term foot pain, he lost sensation and strength in his foot. Despite attempts to restore blood flow, amputation became unavoidable.
“If patients knew what was happening to them, they could come in sooner and we could achieve better outcomes,” Khan said. “We can do a lot for our patients when we catch their symptoms early.”
Awareness saves limbs and can dramatically change lives. The interventional radiology team at UT Physicians is dedicated to treating and managing patients with peripheral artery disease. Reach out to the clinic if you have additional questions about PAD or their services: 713-486-6132.
