Peripheral Arterial Disease (PAD)

Peripheral artery disease is a subset disease of vascular disease, also referred to as peripheral arterial disease (PAD), which develops when excessive plaque buildup on the artery walls, causing narrowing of the arteries. The arteries deliver oxygen-rich blood from the heart to other parts of the body. When plaque builds up, it usually restricts the flow of blood, oxygen, and glucose. The obstruction causes pain in the leg as the muscles and tissues are starved for oxygen and other nutrients from the blood. While the pain usually occurs in your legs primarily, it can also be felt in other parts of the body, including your arms, stomach, hip, head, and kidneys.

Are You at Risk for Peripheral Arterial Disease (PAD)?

In most cases, the PAD symptoms are on the lower extremities. You may experience some pain, craping, or tiredness in your hip or leg muscles when climbing stairs or walking. However, the pain usually goes away with rest, only to resurface when you start walking again. Individuals suffering from peripheral arterial disease are at a high risk of coronary artery disease, stroke, or heart attack. Even worse, if left untreated, the condition can lead to gangrene and amputation.

The most common symptom of Peripheral arterial disease is claudication. The fat and cholesterol build up on the artery walls cause a lack of blood flow, causing a condition referred to as ischemia. Ischemia is a condition that results when there is a greater demand for oxygen than the supply.

Claudication is a condition that causes cramping in the legs and buttocks. As mentioned, the pain and clamping flares up when you start to walk and subsides when you rest. Intermittent claudication affects about 50 percent of individuals suffering from peripheral artery disease. Some of the other common symptoms include loss of hair around the ankles, numbness or coldness in your feet.

Pain and cramping while walking may lead to a more sedentary lifestyle, meaning that the individual will burn few calories and add weight. An increase in weight also increases cholesterol, blood pressure, and other heart disease risk factors. The claudication severity often varies from mild discomfort to debilitating pain, making it hard for you to walk or perform other types of physical activities. Other common symptoms of the peripheral arterial disease include;

• In extreme cases, an open wound or ulcer occurs on your toes or feet. These extreme cases lead to non-healing ulcers. The ulcer can progress to gangrene,    making it hard for you to walk. In such a scenario, immediate medical attention is necessary.
• Weakness or numbness in your legs
• Coldness in your lower feet, especially when you find one foot is colder than the other one.
• Experiencing pain in your feet or toes while you are resting
• Sores on the legs, feet, and toes that do not heal
• Slower toenails growth
• Change in the color of your feet
• Erectile dysfunction in men can be treated by prostate arterial embolization (PAE), which also treats benign prostatic hyperplasia (BPH)
• Weak pulse in your feet or legs
• Developing shiny skin on your legs
• Having pain in your arms, especially when writing, knitting, or performing manual tasks
As the peripheral disease progresses, you may start to experience pain even when you are lying down. In extreme cases, the pain becomes intense enough to distract your sleep. Resting your legs by hanging them at your bed edge or walking around the room helps stimulate blood flow, relieving the pain temporarily.

Atherosclerosis is the primary cause of peripheral artery disease. Atherosclerosis develops when plaque has built up inside the artery wall. The plaque is usually made up of cholesterol and fat buildup. The condition starts when the plaque builds enough to narrow an artery, restricting blood flow. Next, the plaque may become inflamed or brittle, causing a rapture that triggers a blood clot to form. The blood clot will narrow the artery further or block it entirely. Blockages in the arteries can lead to life-threatening conditions. For instance, if the carotid artery is blocked, it can cause a stroke.

If the blockages remain in the legs’ peripheral arteries, it can lead to pain, skin discoloration, sores, and difficulty in walking. In extreme cases, complete loss of circulation to the feet and legs can lead to gangrene and limb loss.

Other common PAD causes

• If you do not have atherosclerosis, the following conditions may also cause Peripheral Artery Disease.
• Injury to your arms or legs
• Exposure to radiation
• Inflammation or infection of a blood vessel
• The irregular shape of your ligaments or muscles

According to the American Heart Association reports, it is estimated that about 8.5 million Americans, most of them aged above 50 years, suffer from PAD. While doctors have not found the exact cause that leads to plaque buildup in the arteries, controlling various PAD risk factors can help in reducing the plaque deposits in the artery.

• Smoking

Smoking is one of the main contributors to the onset of peripheral artery disease. Smoking usually damages the arteries’ inner layers. As the body attempts to heal itself, plaque often builds upon the damaged area. The condition also leads to the formation of blood clots (thrombi). Thrombi tend to stick to the artery walls, narrowing the space for blood flow even further. According to the National Institutes of Health, ceasing to smoke is shown to be effective in reducing or eliminating the PAD effects.

• Lack of Exercise

Lack of exercise is another strong indicator that is connected to peripheral arterial disease. Patients suffering from PAD will benefit enormously by exercising regularly. Regular workouts improve blood flow and boost overall health by reducing blood sugar and blood pressure. It also helps lower cholesterol, which is the main constituent of plaque.

• High Cholesterol, Diabetes & High Blood Pressure

Patients who have diabetes are also at high risk of PAD due to high blood sugar. High blood glucose is connected to plaque buildup in the arteries. Medical practitioners state that controlling Type II diabetes through the proper diet, exercise, glucose monitoring, and medication helps in reducing PAD risks. Patients diagnosed with high blood pressure and high cholesterol are also at increased risks of PAD. Maintaining a healthy diet and exercise can help reduce blood pressure and cholesterol, which is key to reducing PAD risks.

• Blood Vessel Inflammation

PAD is not always linked to plaque buildup in the arteries. The condition may also develop due to blood vessel inflammation, which also causes the arteries to narrow. People with leg injuries may also be at high risk for PAD. The condition is also caused by radiation exposure and unusual ligaments and muscle anatomy.

Other factors that increase the risks of developing artery disease include

• Obesity, especially in people with a body mass index over 30
• People suffering from heart disease. According to The American Heart Association reports, people with heart disease have a 1 in 3 chance of having PAD
• Increasing age, especially people aged over 65 years. Individuals aged 50 years and have the risks factors for atherosclerosis have a higher chance of contracting PAD
• Hereditary factors- if your family has a history of peripheral artery disease, stroke, or heart disease
• People with high levels of Homocysteine. Homocysteine is an amino acid that helps the body to make protein and tissue building
• Gender – males are at a higher risk than females

It is also important to note that in Peripheral arterial disease, the risk factors are addictive. This means that if a person has a combination of two risk factors, such as smoking and high cholesterol, this individual is at an increased risk of having a more severe PAD than an individual with only one risk factor has.

Peripheral Arterial Disease – Diagnosis

At La Jolla Vein & Vascular, we have highly trained physicians who offer a comprehensive diagnosis to develop customized treatments of Peripheral artery disease (PAD). We understand that no two patients’ conditions are similar. Our full-service vascular lab provides state-of-the-art testing to ensure that our physicians address each patient case quickly and accurately. Our doctors and nurses also have broad experience in this field and use advanced tools to achieve limb-saving results even for challenging, impaired patients. Our PAD diagnosis procedure involves the following:

To help diagnose PAD, our skilled doctor will start by doing a thorough physical examination. The doctor will also want to learn about your signs, symptoms, personal health history, risk factors, and family health history. The doctor will ask you several questions regarding your medical conditions, such as diabetes, heart disease, and kidney disease. They will also ask you whether you experience pain or cramps in your leg while walking or exercising.

The doctor will also ask about your family history of PAD and other heart diseases. You will also discuss your smoking habit, either current or in the past. After gathering the information, the doctor will proceed to perform a detailed physical examination. The process involves checking for weak pulses in your leg, listening for poor blood flow in the legs using a stethoscope. The physician will also check for any problems on your legs, such as sores, swelling, and pale skin.

Ankle-brachial index (ABI test) helps diagnose PAD. This test usually compares the blood pressure in your arm with the blood pressure in your ankle. The doctor usually uses a pressure cuff together with an ultrasound device. Sometimes, the physician may request you to walk on a treadmill and have the doctor take the readings before and immediately after the exercise. The procedure will help the doctor to capture the severity of the narrowed arteries.

La Jolla Vein & Vascular doctors also use ultrasound-guided procedures to determine whether a specific vein or artery is blocked or opens. The procedure is non-invasive, meaning that you will not experience any pain. The technique visualizes the artery with sound waves that measure the blood volume that flows in the veins and arteries. After the procedure, the patients receive a thorough consultation. The doctor will recommend the most effective treatment option to help promote blood flow to the feet and leg.

The treatment will help reduce leg pain, promote healing of sores and increase the mobility of the affected limb. Doctors utilize two main ultrasound methods. The first method is the Doppler ultrasound utilized to locate areas with blockages or reduced blood flow. The procedure involves using a handheld device that sends sound waves through the arteries to measure how fast blood flows. The second method is the segmental Doppler pressure testing that checks various parts of the legs for blocked or narrowed arteries. The procedure is similar to the ABI test, but the ultrasound device will amplify the sound of blood flow, making it easy to measure blood pressure.

Angiography is minimal invasive testing that helps to visualize and diagnose blockages inside veins and arteries. In this procedure, the physician will insert a thin tube that injects a special dye that enables blood vessels to appear on an X-ray. As the dye is introduced to the arteries and veins, fluoroscopy imaging captures the detailed images to see the extent of blockages in the arteries.

Doctors also take a sample of your blood to measure the levels of cholesterol and triglycerides. Blood samples are also used to check for diabetes.

MRA tests are conducted to examine the structure of the arteries in your leg. However, the doctor will speak to you before using the procedure. Magnetic resonance angiography is not recommended for people with metal implants in their bodies.


Dr De Young is personable and thorough in his explanations. Exceptional. 

James R.

I am pleased to recommend La Jolla Vein & Vascular. I am in the process of receiving treatment there. The entire medical staff are super friendly, welcoming and very helpful. Everyone is courteous, including the physicians. I’ve had one doctor follow my case. He’s the one who always treats me at appointments and closely follows my health. I am very comfortable going there. Would go again if needed and encourage anyone who’s thinking of making an appointment to do so asap. You’ll see what a wonderful experience it is. It’s the people who make it so special!

Monica M.

From my greeting at the front desk to the ultrasound and visit with the doctor, I received excellent care. It’s clear they care about their patients and all the staff couldn’t have been nicer or more helpful. I also appreciate how much time the doctor spent with me to explain the results and the next steps. I would definitely recommend this office to friends with vein issues. 

Anne S.

We were early and didn’t have to wait at all. The tech that did my husband’s ultrasound, Monica, was very accommodating with my husband’s Parkinson’s. Doctor Lucas whom we hadn’t seen before, came to us instead of making my husband walk down to another office. She spent a lot of time getting caught up on Steve’s background issues/conditions. I was impressed by this medical group before, so I was surprised that the staff was even better this time around; I honestly didn’t think there was room for improvement! 

Linda N.

I have been having leg treatments for several months now La Jolla Vein Care. Every time I go to an appointment; the staff is so friendly and takes such good care of me; always informative; not in a rush and always friendly (especially Alejandra & Anna to name a few). Of course Dr. Lucas is amazing. The treatments have changed my life. Overall this has been an incredible experience. 

Brigid Z.

Beautiful facility! I walked in without an appointment and they took me right away! It was even the end of the day…I was so grateful…Every single person was soooo pleasant! Super impressed ❤️ 

Susan M.

Highly recommend! Entire staff are warm& friendly, professional and accommodating. The doctor took the time to thoroughly explain everything and encouraged me to ask questions. I never felt rushed. Significantly better experience than the other 2 vein clinics I’ve been to on the east coast. I wish I could’ve just come here from the beginning. 


The staff kept you informed as to when you would be seen and the wait was not too long. Emily took care of my ultrasound and was very accommodating giving me an extra pillow and playing a video to watch. The office is very courteous and professional- Nadia answered our questions and offered us a bottle of water. I have been seeing Dr. Bunke, but now Dr. Lucas and will continue coming to La Jolla Vein Care! 

Rebecca D.

I had the best experience at La Jolla Vein Care. Dr.Bunke is an amazing doctor with the best bedside manners, she truly cares about her patients, she explained everything to me. My procedures where so easy I was impressed how painless and fast my appointments. Anna M was very helpful scheduling my treatments and checking on me to make sure all of my questions were answered. I am very pleased thank you !!! I truly recommend La Jolla Vein Care!

Henda S.

Everyone here is so nice! Usually front desk medical personnel are so rude. The front desk ladies Alejandra, Anna, and I think her name is Liz, went above and beyond to take care of me and my insurance issues. The techs are great too! Rachel and a male technician assisted me…both of them implemented different techniques to make me feel more at ease during an uncomfortable and painful process. These procedures were rough…and I am grateful everyone was so sweet to me. Thanks again. 

Melissa B.

When I arrived for the first time, I could barely walk. My legs were red and swollen. After my treatments, I can now walk again. I’m so thankful to the doctor and his staff. They are caring, supporting and knowledgeable about my issues. Five Stars all the way!!!! 

Pamela M.

La Jolla Vein care has the best staff ever. They are so nice, accommodating and professional!! Dr. Bunke is the best doctor that I ever seen. She is so friendly upfront and has the best bed side manner. I thank this office for letting me be their patient. 💜. Plus they are so careful with COVID which I really appreciate!!! 

Darlene H.