Peripheral Arterial Disease

Peripheral arterial disease (PAD) is a condition where the arteries become narrowed or blocked by fatty deposits called atherosclerosis, more commonly known as “hardening of the arteries”.

Whilst this can occur in many arteries in your body, significant problems may arise when this narrowing causes an arterial blockage in the leg.



  • Smoking
  • Diabetes or poor diabetic control
  • High blood pressure
  • High cholesterol
  • Increasing age, especially after reaching 50 years of age
  • A family history of arterial disease

Over the years, cholesterol and calcium build up inside the arteries causing the narrowings. These arterial blockages occur much earlier in people who have these risk factors.

Outcomes of Peripheral Arterial Disease

PAD has the capacity to progress from simple narrowings without many symptoms to conditions that pose increased threats to your legs.

  • Asymptomatic: Narrowing without symptoms. Sign that your risk factors and causes need to be managed.
  • Claudication: Pain in the leg, particularly the calf muscles when walking, particularly walking. It is a pain that occurs at a similar distance each time and is quickly relived by resting. This walking impairment may impair your day to day activities and lifestyle and in 2/3 cases will persist or worsen.
  • Rest pain: A more serious condition of severe burning pain to your toes and feet, that often wakes you from sleep and is only relieved by sitting up in bed or a chair. This is an increasing risk of complication.
  • Ulcers: Wounds or breaks in the skin that don’t heal or worsen often after minor trauma or a new pair of shoes. This may suggest very poor blood supply and is a very serious condition.
  • Other signs or symptoms: Cold feet or legs, discolouration, altered feeling 

People with any of these conditions need management of all their risk factors as underlying PAD suggests a higher risk of stroke or heart attack.

Do I have PAD?

If you have any of the above symptoms or are concerned that you do, please see your General Practitioner in the first instance. They may be able to clarify other possible diagnoses but if they are concerned, they will refer you to a Vascular & Endovascular Surgeon, such as Dr Ponosh.

Whilst walking pain or claudication may limit your lifestyle, it may not require an urgent referral, however if you have rest pain or a non-healing ulcer, an urgent review is essential.

Seeing Dr Ponosh

Your GP may contact Dr Ponosh’s office directly, however in some cases they will provide you a referral to contact the office yourself. Dr Ponosh’s caring and helpful staff will walk you through the process of making an appointment with Dr Ponosh. His staff may also contact you directly. For further information regarding referrals, click here.

When you see Dr Ponosh, he will undertake a full history and appropriate examination. In many instances (if required), he will order appropriate tests before he sees you to streamline your management and avoid unnecessary appointments. These tests are bulk billed at all times if possible. These tests may include ultrasounds, CT scans or blood tests. In some cases, additional tests and appointments may be required.

Based upon Dr Ponosh’s expert review, an appropriate treatment plan will be suggested and explained to you in an open, straight-forward, jargon-free manner with all options and questions addressed.

If you have any questions, please do not hesitate to contact our friendly team on (08) 9386 6200.

Why have treatment?

In many cases, aggressive treatment is not required. In many patients, where there is a minimal lifestyle impact or minimal symptoms, no treatment beyond treating the underlying risk factors that cause the PAD is needed.

In mild symptoms, an active exercise program and risk factor treatment has been shown to have some benefits in improving outcomes especially in those with claudication. Dr Ponosh will discuss this with you if appropriate.

However, treatment is appropriate if you develop:

  • Lifestyle impairing claudication, or intermittent claudication, that has failed conservative management
  • Worsening symptoms
  • Severe disease at risk of adverse outcomes
  • Development or deterioration of non-healing wounds
  • Rest pain

Treatment Options Available

Treatment is different for every patient and depends on multiple factors including; underlying symptoms, nature of your disease, your age and underlying health issues, medications and expected outcomes for you. These treatment options range from minimally invasive procedures to open surgery for more severe conditions. Dr Ponosh takes all these factors as well as his vast personal experience and evidence-based practice to tailor the most optimal treatment for you at the lowest risk and with the best outcome. Your treatment may include one or a combination of the below options.

Conservative Treatment

This means a “watch and wait” approach. As described above, if your PAD is only mild, treatment is not always in your best interests and may not always have the best outcome for you. In these cases, Dr Ponosh in conjunction with your GP and occasionally other specialists such as diabetic or heart specialists (if required) will manage you risk factors improving your long-term outcomes.

Other options such as a walking program may also be discussed with you.

Beyond the medications used to treat your risk factors and some blood thinners like aspirin, there are no other medications shown to make a “real-life” difference in your PAD.

Dr Ponosh may suggest regular review (often annually) to keep a close eye on your PAD. Of course, is you develop any concern’s or worsening symptoms, please contact Dr Ponosh’s office.

Endovascular or Angiographic Treatments

Endovascular or “keyhole” angioplasty treatments are minimally invasive procedures that usually require a day-stay or a short overnight stay. They are undertaken with an anaesthetist usually done under a local anaesthetic with sedation providing a “twilight” anaesthetic. Endovascular surgery and procedures are undertaken through a small needle access through your groin directly into your arteries. They are low risk, essentially pain-free procedures which utilise state of the art modern technologies for excellent outcomes. The results are almost immediate and have a very rapid return to your normal lifestyle.

These procedures allow Dr Ponosh to undertake a diagnostic angiogram to further assess your PAD, and in most cases, proceed to the below procedures during the angiogram to treat and cure your disease:

  • Angioplasty treatment (ballooning)
  • Stenting (implantable permanent scaffolding)
  • Atherectomy (devices to drill/remove disease)


                              Balloon Angioplasty                                                                 Stenting

Please see the section it “What we Do” for information on angioplasty & stenting as well as the video’s in the “Patient” section to see how scenting is done.

Open Surgical Techniques

These are more invasive procedures done through larger open incisions, often under a general or spinal anaesthetic.

Open surgical options may be utilised for more complicated or extensive disease or in some cases where it has been shown to provide the best outcome.

These procedures, whilst shown to be safe and durable, have different and often higher risks than endovascular treatments and are thus only used when appropriate. These procedures may include a bypass operation in which your own vein or a plastic tube is used to bypass the blockage in your artery or an endarterectomy where a more localised blockage is surgically removed.

These procedures often need a 1-night intensive care stay with a 5-7 day stay in hospital. Dr Ponosh would discuss these procedures with you at length.