NHS Patient Information
Peripheral arterial disease (PAD).
National Health Service
Claudication & PAD
Peripheral arterial disease (PAD), sometimes called peripheral artery disease or peripheral vascular disease, is the narrowing of the arteries that supply the legs. It is part of the same systemic atherosclerosis that causes heart attack and stroke, and it is a strong predictor of cardiovascular events as well as a leg problem in its own right.
KONCEPT® runs a consultant-led PAD and claudication clinic at our Kingston upon Thames clinic. Same-day Ankle-Brachial Pressure Index (ABPI) and arterial duplex ultrasound confirm the diagnosis, a structured plan is built around best medical therapy and supervised exercise, and revascularisation referral to a specialist centre is arranged where indicated.
At a glance
Service
Consultant-led
First visit
ABPI + duplex
Therapy
BMT + exercise
Initial consult
from £325
Verified statistics
Drawn from NHS, NICE NG147, the European Society for Vascular Surgery, the Global Vascular Guidelines on Chronic Limb-Threatening Ischaemia, the CAPRIE trial and a Cochrane review of exercise therapy. Every figure links to its citation in the References section at the bottom of this page.
How common PAD is
~2-3×
higher cardiovascular event risk in PAD vs the general population
Outcomes after structured management
50-200%
improvement in walking distance with a structured supervised exercise programme
~20-25%
one-year mortality after presentation with chronic limb-threatening ischaemia
Global Vascular Guidelines[6]
Peripheral arterial disease (PAD) is the narrowing of arteries outside the heart and brain, most commonly the arteries supplying the legs. The underlying process is atherosclerosis, the same process that causes heart attack and stroke. The narrowing reduces blood flow to the muscles, especially during exercise, and in severe disease can threaten the limb[1][3][5].
PAD is a marker of cardiovascular risk, not just a leg problem. Patients with PAD have a higher risk of coronary heart disease, stroke and cardiovascular death than the general population. The PAD page and the cardiovascular risk page need to be read together[5][6].
Symptoms
Rest pain, non-healing foot wounds or black toes may be chronic limb-threatening ischaemia (CLTI) and need urgent vascular assessment. Call 020 8129 1011 or attend urgent care.
Clinical staging
PAD is staged by symptoms using the Fontaine classification[5][6]:
No symptoms (subclinical PAD detected on ABPI).
Intermittent claudication, painless walking distance greater than 200 metres.
Intermittent claudication, painless walking distance less than 200 metres.
Rest pain in the foot or toes, especially at night, relieved by hanging the foot down.
Ischaemic ulcer or gangrene. Together with Stage III, grouped as chronic limb-threatening ischaemia (CLTI), urgent specialist referral required.
Diagnosis
The work-up follows NICE NG147 and ESVS guidance[3][5]:
Where the disease is advanced or limb-threatening, we arrange urgent referral to a specialist centre for cross-sectional imaging (CT or MR angiography) and revascularisation planning[3][5][6].
Initial vascular consultation with duplex ultrasound is £325 (one leg) or £495 (both legs). Please see the pricing page for the full schedule.
Management
PAD management has three tiers: best medical therapy for everyone, supervised exercise for claudicants, and revascularisation referral for severe or limb-threatening disease.
The evidence base supports the same combination of treatments for every patient with PAD, irrespective of stage[3][5][6][7]:
BMT reduces cardiovascular events as much as, or more than, any leg-directed treatment, and is started at the first consultation in collaboration with your GP.
A structured supervised exercise programme is first-line treatment for intermittent claudication per NICE NG147[3]. Programmes typically run 12 weeks with twice or three-times-weekly sessions of treadmill walking interspersed with rest. Published evidence shows 50 to 200% improvement in pain-free walking distance compared with usual care[9].
Where a formal supervised exercise programme is not accessible, structured home-based walking with clear targets is the next-best option.
NICE TA607[8] limits the use of cilostazol, naftidrofuryl oxalate and pentoxifylline as routine treatments for intermittent claudication. They are not routinely recommended in NHS practice, and any use is a consultant-level decision after BMT and supervised exercise have been tried.
For patients with lifestyle-limiting claudication that has not responded to BMT and supervised exercise, or for chronic limb-threatening ischaemia (Fontaine III and IV), your consultant will discuss revascularisation options and refer to a specialist centre. Options include:
KONCEPT® does not perform revascularisation at the Kingston clinic. Cross-sectional imaging (CT angiography, MR angiography) and intervention are arranged at a suitable specialist centre, with the second opinion, pre-intervention planning and post-procedure follow-up at KONCEPT®.
First visit
For full pre-care and post-care instructions, see our Patient instructions page. PAD sits alongside the wound-care and diabetic-foot pathways where relevant.
You receive a written quote before any treatment is booked.
Insurance
PAD assessment and treatment is recognised by most major UK private medical insurers when there is a clinical indication, particularly where there are symptoms of intermittent claudication, rest pain or non-healing wounds. Cover for ongoing best medical therapy, supervised exercise programmes and any onward referral varies by policy.
Recognition at KONCEPT® is at both clinic and consultant level, and cover is expanding. Call 020 8129 1011 with your insurer and policy details and we will come back to you within one working day with confirmation, before any appointment is booked.
Read more on the Insurance & access page →
Your consultants and team
PAD consultations at KONCEPT® are carried out by one of our Consultant Vascular Surgeons, both on the GMC Specialist Register for Vascular Surgery and both Platinum BUPA Consultants. They hold substantive NHS consultant posts at St George’s University Hospitals NHS Foundation Trust and see private patients here on a practice-privileges basis.
Allied-health support includes our HCPC-registered Podiatrist where there is a foot-pressure or diabetic component, and our Tissue Viability Nurse (NMC registered) for any active wound. See Diabetic foot service and Leg ulcer treatment.
FAQs
Peripheral arterial disease (PAD) is the narrowing of arteries outside the heart and brain, most commonly the arteries supplying the legs. The underlying process is atherosclerosis, the same process that causes heart attack and stroke. PAD reduces blood flow to the leg muscles and skin, causes symptoms such as cramping leg pain on walking, and is also a strong marker of cardiovascular risk.
The classic symptom is intermittent claudication, cramping leg pain on walking that comes on after a predictable distance and is relieved by rest. Other symptoms include cold or pale feet, slow-healing foot wounds, foot pain at rest (especially at night), and in severe disease, black or discoloured patches on the toes. Rest pain or non-healing wounds suggest chronic limb-threatening ischaemia and need urgent assessment.
Intermittent claudication is cramping leg pain that comes on with walking and is relieved by rest. It is the most common symptom of PAD and reflects insufficient blood flow to the leg muscles during exercise. It is staged by walking distance using the Fontaine classification.
At KONCEPT® we use a 30 to 45-minute consultation with a Consultant Vascular Surgeon, a careful history and examination, an Ankle-Brachial Pressure Index (ABPI) to confirm the diagnosis, a Toe-Brachial Pressure Index where ABPI is unreliable, and arterial duplex ultrasound on the same visit where indicated to map the disease. Cross-sectional imaging (CT or MR angiography) is arranged at a specialist centre where revascularisation is being considered.
The Ankle-Brachial Pressure Index (ABPI) is a simple, non-invasive test comparing the blood pressure at the ankle with the blood pressure at the arm. An ABPI of 0.9 or below confirms PAD, below 0.5 suggests severe disease. ABPI is also used to confirm compression therapy is safe in patients with venous or lymphatic disease.
Yes. PAD is a marker of systemic atherosclerosis and carries a higher cardiovascular event risk than the general population. In its most severe form, chronic limb-threatening ischaemia (CLTI), it carries a substantial risk of limb loss and a high risk of cardiovascular death within 12 months. Early diagnosis and best medical therapy substantially reduce both risks.
They are largely the same thing. “Peripheral arterial disease” is the term used by NHS and the European Society for Vascular Surgery in the UK and Europe. “Peripheral artery disease” is the equivalent US spelling. “Peripheral vascular disease” is an older umbrella term that can also include venous disease. We use “peripheral arterial disease” on this page.
Treatment has three tiers. Best medical therapy (antiplatelet, statin, blood pressure control, diabetes optimisation, smoking cessation) for every patient. A structured supervised exercise programme is first-line for intermittent claudication. Revascularisation (endovascular or surgical) by specialist referral for lifestyle-limiting claudication that does not respond to BMT and exercise, or for chronic limb-threatening ischaemia.
PAD itself does not reverse, but it can be stabilised, the symptoms can be substantially improved, and the cardiovascular risk can be substantially reduced with best medical therapy and supervised exercise. In selected patients, revascularisation restores blood flow.
Yes. A structured supervised exercise programme is first-line treatment for intermittent claudication and improves pain-free walking distance by 50 to 200% in published trials. The principle is “walk to pain, rest, repeat”, typically over 12-week programmes.
It is rare in patients diagnosed early and managed properly. Risk rises significantly with chronic limb-threatening ischaemia (rest pain, non-healing wounds, gangrene), which is why these symptoms need urgent assessment. With timely revascularisation and good wound care, most CLTI patients keep their limb.
For self-pay, no, you can book directly. Most insurers also allow direct booking. A small number still require a GP referral letter, we will confirm what your insurer needs when you enquire.
Most major UK private medical insurers cover PAD assessment and treatment where there is a clinical indication, particularly for intermittent claudication, rest pain or non-healing wounds. Cover for ongoing supervised exercise programmes and best medical therapy varies by policy. Call 020 8129 1011 with your insurer and policy details before booking.
The first appointment is 30 to 45 minutes with a Consultant Vascular Surgeon, plus ABPI and arterial duplex on the same visit. Allow 60 to 90 minutes for your visit including arrival, reception and the scan.
Surrey catchment also includes Esher, Cobham, Weybridge, Walton-on-Thames, Oxshott and Hampton.
Related vascular services
To book a PAD or claudication consultation with one of our Consultant Vascular Surgeons, or to discuss your case, get in touch.
Email info@konceptmedicalclinic.com · Visit 46-48 Wood Street, Kingston upon Thames, KT1 1UW · See full self-pay pricing →
Regulation and standards
KONCEPT® Medical Clinic is registered with the Care Quality Commission (CQC) for the regulated activities provided at our Kingston upon Thames premises. All consultants are on the General Medical Council (GMC) Specialist Register for Vascular Surgery and remain personally accountable to the GMC under Good Medical Practice. Allied-health clinicians supporting the PAD service are registered with their relevant professional bodies (HCPC for podiatrists, NMC for the Tissue Viability Nurse). Information on this page is written to be factual and verifiable in line with the Committee of Advertising Practice (CAP) Code and Advertising Standards Authority (ASA) rules for medical advertising.
Claims about prevalence, staging, diagnosis, management and outcomes on this page are drawn from NHS, NICE, the European Society for Vascular Surgery, the Global Vascular Guidelines on Chronic Limb-Threatening Ischaemia, the CAPRIE trial and a Cochrane systematic review on exercise therapy. Each source is linked for verification.
Peripheral arterial disease (PAD).
National Health Service
Peripheral arterial disease.
BUPA
Peripheral arterial disease, diagnosis and management (NG147).
NICE, December 2020
Quality Standard QS167, Lower limb peripheral arterial disease.
NICE, August 2018
2017 ESC Guidelines on the Diagnosis and Treatment of Peripheral Arterial Diseases, in collaboration with the European Society for Vascular Surgery (ESVS).
European Heart Journal 2018, 39(9), 763-816
Global Vascular Guidelines on the Management of Chronic Limb-Threatening Ischemia.
Journal of Vascular Surgery 2019, 69(6S), 3S-125S
A randomised, blinded, trial of clopidogrel versus aspirin in patients at risk of ischaemic events (CAPRIE).
The Lancet 1996, 348(9038), 1329-1339
Cilostazol, naftidrofuryl oxalate, pentoxifylline and inositol nicotinate for the treatment of intermittent claudication in people with peripheral arterial disease (TA607).
NICE, May 2011, last updated 2020
Exercise for intermittent claudication.
Cochrane Database of Systematic Reviews 2017, (12), CD000990
Consent, Supported Decision-Making, A Guide to Good Practice.
RCS England, 2018
Last clinical review: Dr Maryam Attarzadeh, Medical Director (GMC 7193218), 2026-05-28. Next review due: 2026-11-28. Statistical claims are re-verified every 6 months, or sooner if peer-reviewed evidence changes.