At the Supreme Vascular and Interventional Clinic in Singapore, Dr. Manish Taneja provides comprehensive assessment and personalised treatment for patients with peripheral arterial disease and other vascular conditions, helping patients make informed decisions based on their symptoms, imaging findings, and overall vascular health.

What Is Peripheral Arterial Disease?

Peripheral arterial disease occurs when the arteries carrying oxygen-rich blood to the legs become narrowed, reducing circulation to the muscles and tissues. The most common cause is atherosclerosis, a process in which cholesterol, calcium, and other substances accumulate within the artery walls to form plaque. As these arteries become progressively narrower, the legs receive less oxygen during physical activity. This often causes intermittent claudication, pain, cramping, or fatigue in the calf, thigh, or buttock that develops while walking and improves with rest.

In more advanced stages, blood flow may become severely restricted, leading to pain at rest, slow-healing wounds, ulcers, or tissue damage. Without appropriate treatment, severe PAD may increase the risk of limb-threatening complications.

Importantly, PAD rarely occurs in isolation. Because atherosclerosis affects blood vessels throughout the body, patients with PAD may also have narrowing of the arteries supplying the heart, brain, kidneys, or other organs. For this reason, diagnosing PAD provides an opportunity to assess overall vascular health and reduce future cardiovascular risk.

Signs & Symptoms of Peripheral Arterial Disease

The symptoms of peripheral arterial disease vary depending on the location and severity of arterial narrowing. Some people experience only mild discomfort during exercise, while others may have no symptoms until the disease becomes more advanced.

Common signs and symptoms include:

• Pain, cramping, or aching in the calf while walking (intermittent claudication)
• Pain in the thigh, buttock, or hip during activity
• Leg fatigue or heaviness after walking short distances
• Symptoms that improve with rest
• Cold feet or lower legs
• Numbness or weakness in the legs or feet
• Slow-healing cuts, wounds, or ulcers on the feet or toes
• Changes in skin colour or temperature
• Reduced hair growth on the legs
• Weak or absent pulses in the feet
• Pain in the feet or toes while resting, particularly at night

Not every person with PAD experiences pain. In some cases, reduced walking distance, slower wound healing, or persistent coldness in one leg may be the earliest signs of reduced circulation.

Because these symptoms may also occur in conditions affecting the spine, joints, muscles, or veins, a comprehensive vascular assessment is often required to determine whether poor circulation is the underlying cause.

What Causes Peripheral Arterial Disease?

Peripheral arterial disease is most commonly caused by atherosclerosis, a condition in which plaque gradually narrows the arteries and restricts blood flow.

Several factors increase the risk of developing PAD, including:

• Smoking or previous tobacco use
• Diabetes mellitus
• High blood pressure (hypertension)
• High cholesterol
• Increasing age
• Chronic kidney disease
• Obesity
• Physical inactivity
• Family history of cardiovascular disease
• Previous stroke or heart attack

Many of these risk factors are shared with coronary artery disease and stroke. As a result, patients diagnosed with PAD often benefit from a comprehensive assessment of their overall vascular health.

Managing these risk factors is an important part of treatment and can help slow disease progression, reduce complications, and improve long-term cardiovascular health.

How Is Peripheral Arterial Disease Diagnosed?

Diagnosing peripheral arterial disease involves more than confirming the presence of narrowed arteries. A comprehensive vascular assessment helps determine the severity of disease, identify the location of arterial narrowing, evaluate your overall circulation, and develop the most appropriate treatment plan. In the early stages, one of the screening tests is a simple non-invasive test called Ankle Brachial Index (ABI) measurement. This involves measuring blood pressure in the arm and leg simultaneously.

Your consultation typically begins with a review of your medical history, symptoms, cardiovascular risk factors, and walking limitations, followed by a physical examination of the lower limbs.

Depending on your symptoms and clinical findings, your vascular specialist may recommend one or more investigations, including:

• Ankle-Brachial Index (ABI) to compare blood pressure measurements in the arms and ankles
• Duplex ultrasound to assess blood flow and identify narrowed or blocked arteries
• CT Angiography (CTA) to produce detailed images of the arteries
• MR Angiography (MRA) for selected patients requiring further vascular imaging
• Catheter angiography, which may also allow minimally invasive treatment to be performed during the same procedure when appropriate

These investigations help determine the extent of arterial disease while guiding personalised treatment recommendations.

Treatment Options for Peripheral Arterial Disease

Treatment for peripheral arterial disease depends on the severity of symptoms, the degree of arterial narrowing, your overall health, and your personal treatment goals. Many patients can successfully manage PAD through a combination of lifestyle modifications and medication, while others may benefit from minimally invasive endovascular procedures or surgery to restore blood flow.

The aim of treatment is to:

• Improve circulation to the legs
• Relieve pain and walking limitations
• Promote wound healing
• Reduce the risk of limb-threatening complications
• Lower the long-term risk of heart attack and stroke
• Improve overall quality of life

Treatment recommendations are always individualised rather than based solely on imaging findings. One of the first things done in patients with PAD is to control their risk factors well with proper medical management such as controlling diabetes, hypertension, high cholesterol, and more.  When conservative measures like medication and lifestyle changes are not enough, advanced, minimally invasive endovascular treatments are used to clear blockages and restore healthy circulation. 

Minimally invasive endovascular treatments for Peripheral Artery Disease offer a safer, faster alternative to open bypass surgery. Performed through a tiny pinhole puncture under local anesthesia, these outpatient procedures allow most patients to go home the same day with minimal downtime. By directly removing plaque and propping open narrowed arteries, treatments like angioplasty, atherectomy, and stenting provide immediate relief from leg pain and cramping, accelerate the healing of non-healing foot ulcers, and significantly reduce the risk of limb amputation. The appropriate treatment depends on whether the artery is narrowed by plaque, blocked by an acute blood clot, or affected by another vascular problem. Dr. Manish Taneja will assess your symptoms, circulation and imaging findings before recommending the most appropriate approach.

• Angioplasty: A tiny balloon is guided into the blocked artery and inflated to push plaque against the vessel wall, widening the passage for blood flow.

• Drug-Coated Balloon Angioplasty: Similar to standard angioplasty, but the balloon is coated with specialized medication that absorbs into the artery wall to help prevent plaque from growing back.

• Atherectomy: A specialized catheter device is used to physically shave, cut, or break down hardened plaque buildup, removing it directly from the vessel.

• Peripheral Arterial Stenting: A tiny, expandable metal mesh tube (stent) is placed inside the artery to act as a permanent scaffold, keeping the vessel propped open after it has been widened.

• Thrombolysis: A targeted procedure where clot-dissolving medicine is delivered directly into a sudden blood clot blocking an artery to rapidly break it down and restore blood flow.

• Mechanical Thrombectomy: uses specialised catheter-based devices to remove blood clots from a blocked artery in selected patients.

Choosing the Right Vascular Specialist

Managing peripheral arterial disease often requires more than treating a narrowed artery.

A comprehensive vascular assessment considers:

• Your circulation
• Stroke and cardiovascular risk
• Existing vascular conditions
• Long-term prevention strategies
• Whether minimally invasive treatment is appropriate

Working with a vascular doctor specialist in Singapore experienced in endovascular procedures helps ensure that treatment decisions are based on your individual circumstances rather than imaging findings alone. Wondering whether it’s time to see a vascular specialist? Learn how specialist evaluation can help diagnose circulation problems, assess vascular risk, and guide personalised treatment decisions in our article, Vascular Specialist: Understanding  Their Role.

Frequently Asked Questions