Peripheral Arterial Disease (PAD)
Peripheral arterial disease is one of the most common vascular conditions I treat in my practice — and one of the most underdiagnosed. Millions of Americans live with narrowed leg arteries, dismissing the warning signs as general aging or fatigue. In reality, PAD is a serious, progressive condition that deserves prompt attention.
At Coastal Vascular Center, I evaluate and treat PAD at both my Pearland and Lake Jackson locations. For most patients, treatment is minimally invasive and performed in the office — no hospital stay required. If you’re experiencing leg pain when walking, cramping, cold feet, or slow-healing wounds on your legs or feet, I want to help you get answers and a clear path forward.
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Board Certified Specialist
Minimally Invasive
Same-Day Procedures
Insurance Accepted
10M+
Americans Have PAD
15%
Of Adults Over 50 Years Old
Minimally Invasive
Most Procedures
20+
Years Experience
Overview
What Is Peripheral Arterial Disease?
Peripheral arterial disease develops when plaque — a buildup of fat, cholesterol, and other substances — accumulates inside the walls of the arteries that carry blood to your legs and feet. This process, called atherosclerosis, gradually narrows the artery's opening and restricts blood flow to the tissue below.
Reduced circulation doesn't just cause leg symptoms. As an interventional radiologist, I always explain to patients that PAD is a whole-body cardiovascular disease. The same plaque buildup that narrows your leg arteries is often narrowing the arteries around your heart and brain. People with PAD have a significantly elevated risk of heart attack and stroke — even if their cardiac symptoms are mild or absent. A PAD diagnosis is a signal that your entire cardiovascular system deserves evaluation.
Who is at higher risk for developing PAD?
- Smokers or former smokers (the single strongest risk factor)
- People with diabetes
- People with high blood pressure (hypertension)
- People with high cholesterol
- Adults over age 50, particularly those over 65
- Anyone with a family history of heart disease, stroke, or peripheral vascular disease
- People who are overweight or physically inactive
If you have two or more of these risk factors, I recommend asking your doctor about PAD screening — especially if you have any symptoms affecting your legs or feet.
Warning Signs
Symptoms of PAD
PAD symptoms often develop gradually and are easy to dismiss as normal aging — but early diagnosis is critical. The condition follows a progressive course, moving from mild discomfort to, in the most severe cases, limb-threatening tissue loss. Knowing what to look for at each stage can make the difference between a straightforward office procedure and a much more complex intervention.
Claudication
The most common early symptom of PAD is claudication — leg pain or cramping that comes on predictably when you walk and disappears after a few minutes of rest. The discomfort typically occurs in the calf, thigh, or buttock, depending on which artery is narrowed. Many patients describe it as a deep ache, heaviness, or tightening sensation. If walking to the mailbox or climbing stairs regularly triggers leg pain that goes away when you stop, that pattern warrants evaluation.
Rest Pain
When PAD progresses, blood flow becomes insufficient even at rest. Rest pain typically presents as a burning or aching sensation in the foot and toes, most noticeable at night or when the legs are elevated. Patients often find that hanging the foot over the side of the bed provides some temporary relief — gravity helps pull what little blood flow remains toward the foot. Rest pain is a serious escalation from claudication and requires prompt evaluation.
Arterial Ulcers
Severely reduced circulation prevents the skin and tissue from receiving the oxygen and nutrients needed to heal. Arterial ulcers are wounds — often on the toes, foot, or lower leg — that are slow to heal or do not heal at all despite standard wound care. They tend to be painful, with a punched-out appearance and pale or necrotic wound beds. If you or a family member has a wound on the foot or leg that has been open for more than two to four weeks, a vascular evaluation is essential.
Gangrene
In the most severe cases of PAD, tissue death can occur due to prolonged oxygen deprivation. Gangrene is a limb-threatening emergency. Affected tissue turns black or dark brown, and infection can spread rapidly. If gangrene develops, immediate vascular intervention is required to attempt limb salvage. My goal in every case is to intervene well before this stage is ever reached.
Additional symptoms that should prompt evaluation:
Persistent coldness or numbness in one leg or foot
Noticeably weak or absent pulse in the leg or foot
Shiny, tight, or discolored skin on the lower leg
Hair loss on the legs or tops of the feet
Abnormally slow-growing toenails
Any one of these findings, particularly in combination with the risk factors listed above, is reason to be evaluated promptly.
WHY PATIENTS CHOOSE COASTAL VASCULAR
A Physician-Owned Practice, Not a Corporate Chain
Dr. Ayar Handles Your Care
Dr. Ayar personally does every consultation and procedure. You will not be handed off to a PA or NP, as at most vein centers.
Two Locations, One Physician
Many vein clinics have many locations and few doctors. At our Pearland and Lake Jackson offices, you always see Dr. Ayar.
Physician-Owned
Coastal Vascular Center is physician-owned, not corporately owned. Your care is guided by your doctor.
Most Insurance Accepted
We accept most insurance plans. Call our office to confirm your coverage before your visit.
Diagnosis
How Is PAD Diagnosed?
When a patient comes to me concerned about their circulation, I take a thorough, step-by-step approach to diagnosis before recommending any treatment. The goal is to understand exactly where the problem is, how severe the narrowing is, and whether intervention is appropriate.
Ankle-Brachial Index (ABI)
At Coastal Vascular Center, we utilize the Ankle-Brachial Index (ABI) test as a non-invasive diagnostic tool to assess and identify potential vascular issues in the lower extremities, which can indicate peripheral artery disease and other circulatory conditions; this simple procedure measures the ratio of blood pressure in the ankle to that in the arm, providing essential insights into the efficiency of blood flow and helping our specialists determine appropriate treatment options to enhance vascular health and overall well-being.
Duplex Ultrasound
This non-invasive imaging study utilizes sound waves to create a detailed map of blood flow through the arteries in real time, enabling healthcare providers to visualize any narrowed or blocked segments effectively. By measuring flow velocity, this technique helps to identify which arteries are most impacted, providing crucial information for diagnosis and treatment, all without exposing patients to radiation or the use of dyes.
CT Angiography or MRA
For patients undergoing an interventional procedure, comprehensive cross-sectional imaging is essential as it provides crucial insights into the specific anatomy of the blockage, including its length, location, and the condition of adjacent vessels. This detailed understanding enables me to determine the most effective treatment strategy even before we begin the procedure.
I will not recommend a procedure without completing the diagnostic workup that justifies it. Clear imaging, a full medical history, and an honest conversation about your goals are the foundation of every treatment decision I make.
Our Approach
PAD Treatment Options at Coastal Vascular Center
Treatment depends on the severity of your PAD and your overall health. My goal is always to use the least invasive approach that delivers lasting results. For most patients, I can restore meaningful blood flow and relieve symptoms without an overnight hospital stay.
Lifestyle & Medical Management
First-line approach for mild to moderate PAD
At Coastal Vascular Center, we know that improving your vascular health can feel overwhelming, especially with conditions like peripheral artery disease. Our approach goes beyond just treating symptoms; we focus on equipping you with the information and personalized plans you need to manage your condition effectively. With dedicated support and customized lifestyle changes, we strive to ease your worries and improve your quality of life. Together, we'll work through your unique recovery journey, ensuring you feel informed and confident along the way.
Smoking cessation is the single most important step any PAD patient who smokes can take. Continued smoking dramatically accelerates disease progression and reduces the effectiveness of any vascular procedure.
Supervised exercise therapy — typically a structured walking program — is one of the most well-evidenced treatments for claudication. Over weeks to months, many patients significantly extend the distance they can walk before symptoms occur.
Antiplatelet agents could reduce the risk of blood clots. Statins lower cholesterol and help stabilize plaque. Blood pressure medications protect the vascular system more broadly.
Ongoing program
Angioplasty
Minimally invasive, same-day procedure
When lifestyle management is insufficient or the disease has progressed, consider angioplasty as an effective initial endovascular procedure. This minimally invasive approach involves threading a small balloon catheter through the skin to the narrowed area, where it is inflated to compress plaque against the artery wall. This process widens the opening and restores vital blood flow, making it a proactive step towards better vascular health.
The procedure is minimally invasive, performed under local anesthesia, and completed in the office procedure suite.
Most patients go home the same day and experience a noticeable improvement in circulation within days.
Recovery is typically measured in days, not weeks.
Same-day procedure
Atherectomy
Ideal for heavily calcified blockages
In situations where arteries are narrowed by calcified or hardened plaque, atherectomy stands out as a superior initial option compared to balloon angioplasty alone. This innovative procedure goes beyond merely compressing the plaque; it employs a specialized catheter-based device to meticulously remove plaque from the artery wall, using techniques such as shaving, drilling, or vaporizing to effectively restore healthy blood flow.
I have several atherectomy modalities available and select the approach based on plaque characteristics, artery anatomy, and location.
Atherectomy is particularly effective in heavily calcified vessels where balloon inflation alone might not achieve adequate results.
It can significantly improve the procedure's durability.
1-2 hour procedure
Stenting
Maintains long-term artery openness
After undergoing angioplasty and occasionally after atherectomy, I may recommend the placement of a stent to help preserve the artery's newly enlarged diameter. This stent is a small, flexible mesh tube that is permanently positioned within the artery, serving as a supportive scaffold to ensure it remains open for optimal blood flow.
I use stents when the artery is at higher risk of re-narrowing (restenosis) based on its anatomy, the length of the treated segment, or the patient's specific disease characteristics.
Drug-eluting stents — coated with a medication that slowly releases into the surrounding tissue are available and can further reduce the risk of restenosis in appropriate patients.
The decision to stent is made based on the individual case, not as a routine step in every procedure.
Same-day procedure
Critical Importance
Why Early Treatment Matters
PAD is a progressive disease. Without treatment, the reduced blood flow to your legs and feet will typically worsen over time — and the consequences of delay become more serious at each stage.
The most severe form of PAD is called Critical Limb Ischemia (CLI). At this stage, blood flow is so severely compromised that rest pain is constant, wounds cannot heal, and gangrene may develop. CLI carries a substantial risk of limb loss — amputation — within months without aggressive vascular intervention.
Early treatment changes that trajectory completely. When I see a patient in the claudication stage, we have excellent, minimally invasive options and plenty of time to use them carefully. When a patient arrives with an infected non-healing wound or early gangrene, the situation is urgent and the options are narrower.
My goal is always limb salvage — preserving your quality of life and keeping you mobile. Patients who come to me early give us the best possible chance of achieving that together. If you have been told to “just live with” leg pain, or if you have noticed a wound on your foot that is not healing, please do not wait.
My goal is always limb salvage. Patients who come to me early give us the best possible chance of preserving your mobility and quality of life. Do not wait until the disease is advanced.
Your Specialist
Why Choose Dr. Ayar for PAD Treatment?
Board-Certified Interventional Radiologist
As a board-certified interventional radiologist, peripheral arterial disease is one of my core clinical areas. This is not a condition I treat occasionally — it is central to what I do every day in my practice.
Full-spectrum PAD care — I treat patients at every stage, from early claudication to critical limb ischemia. My approach is comprehensive and calibrated to where you are in the disease process.
Minimally invasive, in-office procedures — Angioplasty, atherectomy, and stenting are performed in the office procedure suite for most patients. That means no hospital admission, lower risk, and faster recovery.
Diagnostic-first approach — I will not recommend a procedure without the imaging and evaluation that justify it. You will always understand why I am recommending a particular treatment and what the alternatives are.
Two convenient locations — I see patients at my Pearland office at 8619 Broadway St, Suite 105, and at my Lake Jackson office at 201 Oak Dr South, Suite 105. Patients across Brazoria County, including those from Angleton, Alvin, Friendswood, and surrounding communities, can access specialized vascular care close to home.
Subspecialty focus — My training in vascular and interventional radiology means PAD care is a core competency, not a side service. You are seeing someone who has dedicated their career to exactly this type of problem.
Patient Stories
PAD Treatment Options at Coastal Vascular Center
Hear from patients who trusted Dr. Ayar with their vascular health — and got their lives back.
FAQS
PAD Frequently Asked Questions
What is the difference between PAD and cardiovascular disease?
Can PAD be reversed or cured?
PAD cannot be fully reversed or cured, but its progression can be slowed substantially with lifestyle changes, medications, and vascular procedures. Minimally invasive treatments like angioplasty and stenting can restore meaningful blood flow and relieve symptoms very effectively. The goal of treatment is to reduce symptoms, prevent complications like non-healing wounds and limb loss, and lower the overall cardiovascular risk PAD represents. Many patients experience significant improvement in quality of life and walking capacity after treatment.
Is PAD treatment covered by insurance?
In most cases, yes. PAD diagnosis and treatment — including ABI testing, duplex ultrasound, angioplasty, atherectomy, and stenting — are medically recognized procedures covered by Medicare, Medicaid, and most private insurance plans when clinically indicated. Coverage depends on your specific plan and the documentation of medical necessity. Our office team works with patients to verify benefits and navigate prior authorization requirements before any procedure.
What happens if PAD is left untreated?
Without treatment, PAD typically progresses. Mild claudication can advance to rest pain, then to non-healing arterial ulcers, and in the most severe cases to gangrene and potential limb loss. Beyond the legs, untreated PAD reflects ongoing systemic atherosclerosis — meaning the risk of heart attack and stroke remains elevated. Early intervention at the claudication stage offers the best outcomes with the least invasive approaches. Waiting until the disease is advanced significantly narrows the available options.
How long does recovery take after angioplasty or atherectomy?
Recovery from angioplasty and atherectomy is typically brief. Most patients go home the same day and can return to normal, light activity within one to two days. The access site — usually a small puncture in the groin or below the knee — heals quickly. Patients often notice improved circulation and relief from claudication symptoms within days of the procedure. I provide specific post-procedure instructions tailored to each patient's case, and I am available to answer questions during recovery.
Should I see my primary care doctor or a specialist for PAD?
Your primary care physician is a great starting point — they can order an ankle-brachial index (ABI) test and assess your overall cardiovascular risk. However, if the ABI is abnormal, your symptoms are progressing, or you have any wounds on your legs or feet that are not healing, you should be evaluated promptly. I offer direct consultations for patients concerned about their circulation, and I work closely with primary care physicians and cardiologists to coordinate care as needed. A referral is welcome but not required to schedule an appointment.
Learn More
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Schedule Your PAD Consultation
If you are experiencing leg pain when walking, cramping that goes away with rest, persistent coldness or numbness in your feet, or a wound on your leg or foot that is not healing, do not wait to get it evaluated. PAD is a serious, progressive condition — but with the right care, it is very treatable. I see patients at Coastal Vascular Center in Pearland and Lake Jackson, serving Brazoria County and surrounding communities throughout the Houston region.
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