CONDITIONS WE TREAT
Peripheral Artery Disease (PAD)
PAD is the narrowing of the arteries that carry blood to the legs and feet, from the same plaque buildup (atherosclerosis) behind heart attacks and strokes. It is common, often underdiagnosed, and highly treatable. Whatever stage you're at, the goal is the same — keep you walking, independent, and whole. Leg pain isn't simply part of getting older, and the sooner it's checked, the more we can do.
What it is
As the leg arteries narrow, muscle and skin receive less blood. Early on this causes leg pain with walking (claudication); as it advances it brings pain at rest, wounds that won't heal, and — in the most severe stage — the threat of amputation. PAD also signals widespread atherosclerosis, which is why it raises the risk of heart attack and stroke.
Why it matters
Risk Factors
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Smoking or tobacco use (the strongest modifiable risk factor)
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Diabetes
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Age 65+ (or 50+ with diabetes or a smoking history)
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High blood pressure and high cholesterol
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Chronic kidney disease
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Known atherosclerosis in the heart or carotid arteries; family history
Diagnostic Testing
We diagnose non-invasively in our in-house vascular lab, escalating only as needed:
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Ankle-brachial index (ABI), with exercise testing when resting values are borderline
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Arterial duplex ultrasound to map where flow is reduced
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Pedal ultrasound with pedal acceleration time (PAT) — the small foot arteries that matter most for healing
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Angiography — detailed artery imaging when planning a procedure
Treatment options
Medical & conservative therapy
The foundation at every stage — and often all that early PAD needs:
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Quitting tobacco
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A supervised walking / exercise program (see Managing your PAD, below)
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A statin, plus antiplatelet or low-dose anticoagulant therapy to lower clot and cardiovascular-event risk
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Blood-pressure and diabetes control
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Cilostazol for selected patients with claudication
Invasive treatment
When flow must be restored, we reopen arteries through a small puncture — matched to the level of disease:
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Aortoiliac (inflow) · femoropopliteal · below-the-knee & pedal
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Using angioplasty, drug-coated balloons, and selective stenting
Below-the-knee work is the center of our practice — Dr. Comstock and Dr. Evans are fellowship-trained interventional cardiologists whose practice is centered on below-the-knee and below-the-ankle (BTK/BTA) revascularization.
Claudication — the most common early symptom
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Claudication is cramping or aching in the leg muscles that comes on with walking and eases with rest — muscle pain from too little blood flow during activity. It is the most common symptomatic form of PAD; lifestyle-limiting claudication corresponds to Rutherford classification stage 3.
Where you feel it points to the level of blockage:
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Calf pain points to the thigh-and-knee (femoropopliteal) arteries
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Hip, buttock, and thigh pain points to the inflow (aortoiliac) arteries
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Bilateral hip/buttock claudication with absent groin pulses — and, in men, erectile dysfunction — is the classic pattern of aortoiliac occlusive disease (Leriche syndrome)
First-line care is a structured walking program, tobacco cessation, a statin and antiplatelet therapy, and cilostazol for selected patients. When symptoms limit daily life despite that, we restore flow with minimally invasive revascularization matched to the level — aortoiliac, femoropopliteal, or below-the-knee & pedal.
Managing your PAD day to day
Treating a blockage restores blood flow — but keeping your arteries healthy is what protects your legs for the long run. These daily choices slow the disease and lower your risk of heart attack and stroke:
Stop smoking — the single most important step
Nothing damages your arteries, or undoes the benefit of treatment, faster than tobacco. Quitting is the most powerful thing you can do for your legs, your heart, and your life — and we can help. Nicotine & Tobacco →
Keep moving — walking is medicine
Regular walking helps your body build new pathways for blood flow and can meaningfully increase how far you can walk before pain. Walk until moderate discomfort, rest until it eases, then walk again, most days. If you have a wound or rest pain, check with us first.
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Diabetes — steady blood sugar protects both nerves and the small arteries that matter for healing
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Cholesterol — most patients with PAD benefit from a statin
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Blood pressure — keeping it controlled reduces strain on your arteries
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Daily foot checks — catch cuts, blisters, and sores early (Diabetic Foot Ulcers →)
When to call us — don’t wait for your next visit
Advanced artery disease can worsen fast. Call us right away — don’t wait for your next scheduled visit — if you notice any of these:
Call our office today if you notice:
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New or worsening pain in the foot or leg — especially pain at rest or at night
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A new wound, or an existing wound getting larger or draining
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Black or darkening toes or skin
Call our office at (918) 943-5303 and tell us what’s changed — we’ll get you seen sooner, because catching these early often keeps a small problem from becoming a big one.
Go to the emergency room now, or call 911, if you have:
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A foot or leg that becomes suddenly cold, pale, numb, or painful
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An infection that is spreading quickly, or a fever with a wound
Frequently asked questions
For referring providers — We welcome referrals across the full spectrum of PAD, from claudication to advanced limb-threatening disease. Refer: (918) 943-5303 · fax (855) 312-3594.
Refer urgently: rest pain, a nonhealing wound, or gangrene · Routinely: claudication limiting function despite therapy, ABI ≤ 0.90, or noncompressible ABI > 1.40 in diabetes. Full referral guide →