Peripheral Arterial Disease: Why Early Detection Matters

 According to a 2026 systematic review and modeling analysis published in The Lancet Global Health, an estimated 316.54 million individuals aged 25 years or older worldwide had peripheral arterial disease (PAD) in 2023. In its early stages, PAD may cause intermittent claudication; however, the condition can remain undiagnosed until it has progressed to more advanced disease.

“We must bring peripheral arterial disease (PAD) out of the shadow of other cardiovascular diseases,” said Farzin Adili, MD, PhD, director of the Clinic for Vascular Medicine, Vascular Surgery and Endovascular Surgery at Klinikum Darmstadt in Darmstadt, Germany; president of the German Society for Vascular Surgery and Vascular Medicine (DGG); and president of the 2026 DGG Congress, at a DGG press conference.

DGG calls for greater awareness, prevention, and targeted early detection among people at increased risk.

“PAD is not a rare condition. It is a common, widespread disease with serious consequences for those affected and for our healthcare system, yet it is all too often not diagnosed until it is already at an advanced stage,” said Christian-Alexander Behrendt, MD, vascular and endovascular surgeon and head of the Department of Vascular and Endovascular Surgery at the Asklepios Clinic Wandsbek in Hamburg, Germany.

Disease Develops Unnoticed

In PAD, the arteries in the legs become abnormally narrow. The condition can develop unnoticed over many years. Although arterial narrowing is already present in the early stages, blood flow may remain sufficient during everyday activities to adequately supply the muscles and tissues, leaving patients without symptoms.

Important risk factors include smoking, hypertension, and lipid disorders. Diabetes is a major risk factor. It now affects almost 540 million individuals worldwide, and according to Behrendt, approximately half of those affected will develop severe circulatory impairment during their lifetime.

In advanced stages, PAD can substantially impair mobility and quality of life and threaten both limbs and life. The long-term data illustrate the severity of the condition.

“For patients whose legs suffer from chronically poor blood flow, the risk for amputation or death within 5 years can rise to as high as 88%, depending on their individual health status,” Behrendt said.

Long-term mortality rates and cancer incidence are higher in patients with PAD than in those with other cardiovascular diseases. Depending on the risk profile and disease stage, up to 90% of patients may have died, undergone amputation, or developed a new malignant cancer within 5 years of their first hospital treatment for symptomatic PAD.

Data from the Hamburg City Health Study illustrated the extent of undiagnosed PAD in Germany. In the only population-based screening study conducted to date, about one quarter of adults aged 45-74 years had an ankle-brachial index (ABI) below 0.9, a value considered diagnostic of narrow leg arteries and associated with an increased cardiovascular risk.

The ABI is a simple, painless test that compares blood pressure at the ankle with blood pressure in the upper arm. Values below 0.9 indicate narrowed arteries in the pelvis or legs. In addition, approximately 1 million people with public health insurance are diagnosed with PAD in hospitals. “However, we lack robust data for outpatient care, and the number of unreported cases is considered high,” Behrendt said.

A recent analysis of health insurance data highlights the importance of timely diagnosis: When PAD was diagnosed before the first hospital treatment, treatment outcomes were better, and treatment was associated with fewer complications. Early diagnosis can facilitate smoking cessation and other lifestyle changes, as well as optimal medication therapy.

The early identification of at-risk individuals paves the way for evidence-based preventive measures. DGG calls for individuals with risk factors to receive targeted counseling and undergo ABI testing. “We need to reach people at risk earlier. Counseling and simple vascular diagnostics can help detect PAD before invasive outpatient or inpatient treatment becomes necessary for the first time,” Behrendt said.

Prevention Can Reduce Costs

Suitable prevention programs for early detection and preventive medical care are not yet available. The course of action in an outpatient setting depends heavily on individual factors. Socioeconomic, sex-specific, and health system factors play an important role in the development, diagnosis, and treatment of PAD.

Targeted prevention can reduce individual suffering and healthcare costs, Adili said, “In Germany, peripheral arterial disease is treated with highly invasive methods, using catheter techniques or surgery.”

Adili noted that in other countries, patients receive supervised walking training. This structured, guided, and regular exercise can promote the development of collateral vessels and improve blood flow to the extremities.

“Walking therapy therefore does not consume material resources such as catheterization equipment, does not require hospital stays, keeps patients mobile, and prevents other comorbidities, such as cardiovascular diseases. That would be a simple way to reduce costs as well,” Adili said. However, such preventive efforts would require political and financial support.

For the first time, The Lancet is dedicating a comprehensive clinical series to PAD and the vascular complications of diabetic foot syndrome. Three articles address diagnosis and screening, treatment, and the global significance of the disease. Behrendt is coordinating the series from a medical and scientific perspective. These articles were published online on September 23.

https://www.medscape.com/viewarticle/peripheral-arterial-disease-why-early-detection-matters-2026a100100c