Peripheral artery disease (also known as peripheral arterial disease or PAD) is a circulatory condition in which the peripheral arteries are narrowed, restricting blood flow. These arteries are responsible for carrying blood away from the heart to the arms, legs, stomach, and head.

In the United States, more than 8 million people age 40 and older have PAD. The most common type of PAD is called lower extremity PAD because it affects the feet and legs.

Causes of Peripheral Artery Disease

PAD is mainly caused by atherosclerosis, or the buildup of deposits (known as plaques) in the arteries. Plaques are made up of cholesterol, calcium, fat, and fibrous tissue. This buildup narrows the arteries, which limits the amount of blood flowing through them.

Atherosclerosis is a slow-progressing condition that develops over many years and is believed to begin with damage to an artery. This damage can then invite buildup as blood cells and fatty deposits clump at the site of injury. Over time, plaque buildup forms and hardens, which can block off blood flow through the artery.

In some cases, the plaques break off and flow through the bloodstream. The plaques can also rupture and create blockages in other arteries, which can lead to a heart attack or stroke.

The inner layer of an artery can be damaged by many things, including:

• High cholesterol
• High blood pressure
• Cigarette smoking
• High triglyceride (fat) levels in the blood
• Inflammation from autoimmune diseases, such as lupus, arthritis, inflammatory bowel disease, or psoriasis
• Diabetes
• Obesity

Risk Factors for Developing PAD

Several different factors play into the likelihood of developing PAD — some can be controlled and others cannot. These risk factors include:

• Older age (age 65 and older)
• Family history of PAD, stroke, heart disease, or blood vessel disease (such as vasculitis)
• Smoking, not exercising enough, and unhealthy eating habits
• High cholesterol or triglyceride levels
• High blood pressure
• Obesity
• Metabolic syndrome
• Stress
• Chronic kidney disease
• Blood clotting disorders
• Race and ethnicity (African Americans are at a higher risk of developing PAD)

PAD affects men and women at similar rates, but the disease can affect men and women differently. Women are more likely to have PAD without symptoms and to have related complications.

Symptoms of Peripheral Artery Disease

Symptoms of PAD vary from person to person and can include:

• Leg pain, cramping, aching, or heaviness when walking or exercising that goes away after rest (known as intermittent claudication)
• Pale, blue, or discolored skin on your feet and legs
• Slow growth of leg hair or toenails
• Pins and needles sensation in your feet or legs
• Temperature differences between one leg and the other
• Leg numbness or weakness
• Sores on your legs, feet, or toes that heal slowly or not at all

Roughly 20 percent of people with PAD report no symptoms, and only about 25 percent experience these common symptoms.

Complications of Peripheral Artery Disease

Over time, the damage caused by lack of blood flow to the legs and feet can have lasting effects, including mobility problems that make everyday activities difficult without help.

Critical Limb Ischemia

Limited blood flow to the legs can result in a condition known as critical limb ischemia. Signs and symptoms of critical limb ischemia include leg pain when resting, sores and infections that heal slowly or not at all, and gangrene (tissue death) in severe cases. In cases of gangrene, the tissues may become too infected to heal, and amputation may be required.

Acute Limb Ischemia

Acute limb ischemia may be suspected if you suddenly lose feeling in your foot, if one foot becomes paler, bluer, or colder than your other foot, or if you cannot move your foot. These symptoms are due to a sudden drop in the blood flow to your leg. Acute limb ischemia is a medical emergency — call emergency services immediately and seek medical help.

Infections

PAD can cause numbness and sores in the legs and feet. If these sores become infected, the infection can spread to the bloodstream or other tissues. Depending on the severity of the infection, you may be treated with antibiotics, or in the hospital. People with both diabetes and PAD tend to be at a higher risk of developing sores and infections.

Diagnosing Peripheral Artery Disease

The first step in treating PAD is diagnosing the condition. Your doctor will likely take a detailed medical history and ask about your signs and symptoms as well as any family health history of PAD and other cardiovascular conditions. The doctor will also likely perform a physical exam and check for weak pulses and blood flow in the legs, as well as for pale skin, sores, and swelling. Further diagnostic tests that are performed for PAD include:

• Magnetic resonance angiography
• Ankle-brachial index (ABI)
• Doppler ultrasound

Magnetic Resonance Angiography

Magnetic resonance angiography is a specific type of imaging scan that looks at the blood vessels in your legs. In some cases, contrast dye may be injected into the veins to visualize the blood vessels more easily.

Ankle-Brachial Index

The ABI is a test that compares the blood pressure measured in your arm with the blood pressure measured at your ankle. Inflatable blood pressure cuffs are attached to your arm and ankle, and an ultrasound device is used to look at the blood vessels and listen to your pulse.

Your doctor will calculate a number, called the ABI, based on the results. A low ABI indicates that there is narrowing or blockage of the arteries in your legs — a sign of PAD.

Doppler Ultrasound

A Doppler ultrasound is used to find specific areas where blockages and reduced blood flow are occurring. A Doppler ultrasound can also measure how quickly the blood is flowing through the arteries. This test uses a handheld ultrasound device that is moved over the skin and uses sound waves to develop pictures of your arteries and the blood flow.

Treating Peripheral Artery Disease

The types of treatment you receive depend on the severity of your PAD and the complications you may have developed. The overall goals are to minimize symptoms and improve quality of life, especially by reducing the risk of complications and improving your ability to do everyday activities.

Healthy Lifestyle Changes

PAD is a circulatory condition that can be improved by maintaining good heart health. Your doctor may recommend some lifestyle changes to promote your overall health. These include:

• Choosing a healthy diet of whole grains, fruits, and vegetables, while limiting salt, saturated fats, alcohol, and added sugars
• Managing stress and getting good-quality sleep
• Quitting smoking
• Getting regular exercise and maintaining a healthy weight

Medications

In addition to lifestyle changes, your doctor may prescribe you medication to help treat your PAD.

Statins

Statins are cholesterol-lowering drugs that help reduce your risk of heart attack or stroke. Examples include:

• Atorvastatin (Lipitor)
• Rosuvastatin (Crestor)
• Lovastatin (Altoprev)
• Simvastatin (Zocor)

Blood Thinners

Blood thinners help prevent blood clots from forming and help improve blood flow to the legs. One example is clopidogrel (Plavix).

Antihypertensives

Antihypertensives are high blood pressure medications used to help improve cardiovascular health. These include angiotensin-converting enzyme inhibitors and angiotensin II receptor blockers.

Symptom Relief Medications

These drugs help improve blood flow to the legs by thinning the blood and widening the blood vessels. Examples include cilostazol (Pletal) and pentoxifylline (Pentoxil).

Blood Sugar Management

Medications that help control your blood sugar can also be useful, especially if you have diabetes as well as PAD.

Surgical Treatments

In severe cases of PAD causing claudication (pain in the legs or arms that happens when you walk or use your arms), surgical treatments may be necessary.

Angioplasty

An angioplasty can be performed to flatten a plaque against the artery wall, reopening the artery. This effect increases the blood flow to the leg and improves PAD symptoms. To perform an angioplasty, the doctor inserts a long, thin, flexible tube called a catheter through a blood vessel to the artery. At the tip of the catheter is a small balloon the doctor can inflate, which flattens the plaque. Your doctor may also insert a stent, or a mesh tube, to help keep the artery open.

Thrombolytic Therapy

In this procedure, the doctor injects a drug directly into a blocked artery to dissolve the blood clot.

Bypass Surgery

This technique allows your doctor to “bypass” a blocked artery by making a new path using a synthetic vessel or another blood vessel from your body.

Talk With Others Who Understand

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