When most people picture a PAD patient, they imagine an older man with calf pain when walking. That image isn’t wrong — but it’s dangerously incomplete. Peripheral artery disease affects women at nearly equal rates as men, yet women are diagnosed less frequently, treated less aggressively, and experience worse outcomes.
A 2023 AHA Scientific Statement on health disparities in PAD identified sex-based differences in diagnosis and treatment as a major contributor to adverse outcomes in women. The problem isn’t that women don’t get PAD — it’s that the medical system often doesn’t recognize it when they do.
How PAD Presents Differently in Women
The classic PAD symptom — intermittent claudication, defined as reproducible cramping in the calves with walking that resolves with rest — is more reliably reported by men. Women with PAD are more likely to present with atypical symptoms: general leg fatigue or heaviness, difficulty walking that they attribute to aging or deconditioning, hip or buttock discomfort rather than calf pain, slower walking speed without acute pain, and symptoms that don’t fit the classic “walk-stop-rest-repeat” pattern.
These atypical presentations mean that women are less likely to be screened with an ankle-brachial index (ABI), less likely to be referred to a vascular specialist, and more likely to be told their symptoms are “just getting older” or misdiagnosed as musculoskeletal or neurological problems.
The Screening Gap
The 2024 ACC/AHA PAD Guideline recommends ABI screening for all patients over 65 or over 50 with atherosclerotic risk factors — regardless of sex. Yet real-world data shows that women receive ABI testing at lower rates than men with equivalent risk profiles.
This screening gap has consequences. Women with PAD are diagnosed at later stages, have higher rates of critical limb-threatening ischemia at presentation, and experience higher amputation rates relative to their disease burden — not because their disease is inherently more aggressive, but because it’s caught later.
Treatment Disparities
Even when PAD is diagnosed in women, treatment patterns differ. Studies show women are less likely to be prescribed guideline-directed medical therapy (statins, antiplatelets), less likely to be referred for structured exercise programs, and less likely to undergo revascularization when clinically appropriate. The 2024 guideline explicitly calls for equitable application of its recommendations across sex and gender.
What Women Should Know
If you’re a woman over 50 with risk factors for vascular disease — smoking history, diabetes, hypertension, high cholesterol, family history of heart disease or PAD — you should know that leg symptoms in women may not look like the textbook description. Any persistent change in walking ability, leg fatigue, or discomfort with activity warrants evaluation. An ABI test takes 15 minutes, is painless, and can identify PAD years before it becomes limb-threatening.
At Surgical Associates, Dr. Rodeen Rahbar provides comprehensive PAD evaluation and treatment for women across Maryland, DC, and Northern Virginia. ABI screening is available at all five locations. No referral is required.
What to ask your doctor: “I have risk factors for vascular disease. Should I be screened for PAD with an ABI test?”
FAQ Schema:
The Bottom Line
PAD doesn’t discriminate by sex — but the healthcare system’s detection of it sometimes does. Women deserve the same screening, the same evidence-based treatments, and the same access to vascular specialists as men. If your leg symptoms have been dismissed, consider a vascular evaluation.
Schedule a PAD screening: Call (240) 427-1630 or visit www.sacmd.com
Disclaimer: This article is for informational purposes only and does not constitute medical advice.
References:
- Allison MA, et al. Health Disparities in Peripheral Artery Disease. Circulation. 2023;148:286-296.
- Gornik HL, et al. 2024 ACC/AHA PAD Guideline. JACC. 2024;83(24):2497-2604.
- Mayo Clinic. Peripheral Artery Disease — Symptoms and Causes. mayoclinic.org.
- Cleveland Clinic. Peripheral Artery Disease in Women. clevelandclinic.org.
Dr. Rahbar is an esteemed vascular surgeon at Surgical Associates, known for their exceptional contributions to the field of vascular surgery. As a board-certified vascular surgeon with over 20 years of invaluable experience, Dr. Rahbar is a respected authority in the medical community serving Camp Spring, Maryland and the whole community of Maryland. Their unwavering dedication to providing advanced care for patients with diseases of the arteries and veins has earned them a reputation for excellence. Dr. Rahbar’s work embodies a passion for precision and compassion, improving the lives of those they serve, one procedure at a time.