Peripheral artery disease (PAD)

Most often, the first symptom of PAD is leg discomfort when you’re active. This happens when your arteries can’t keep up with your muscles’ increased demand for blood. As PAD progresses, you may have leg or foot pain when you’re resting. But many people have no symptoms and are only diagnosed through screenings.

Possible symptoms include:

• Leg discomfort when active: You might feel pain, cramping, numbness or fatigue in your calves, thighs or butt. It starts during physical activity, like walking or climbing stairs. And it stops when you stop moving — typically within 10 minutes. 
• Leg discomfort when resting: This can occur as PAD gets more severe. You’ll feel a burning or aching pain in your legs, feet or toes. This often happens when you’re lying flat. Dangling your leg or feet over the edge of your bed may relieve the pain.
• Foot and toe ulcers: These are wounds on your skin that may get infected. They can take a long time to heal.
• Changes in skin color or temperature: A sudden blockage in your artery can make your skin turn purple, green, black or very pale. Your skin may also feel cool to the touch or like “pins and needles.” These are signs of severe PAD. Seek medical care immediately.

Exactly where you feel leg discomfort depends on which artery is too narrow. Symptoms occur below the affected artery:

• Discomfort in your butt, hip or thigh: There’s narrowing of your lower aorta or iliac arteries (in your pelvic area).
• Discomfort in your calf: There’s narrowing of your femoral or popliteal arteries (in your thigh and knee area).

Males might also experience erectile dysfunction related to peripheral artery disease when there’s narrowing of the lower aorta or iliac arteries.

PAD treatment depends on how far the condition has progressed. If you don’t yet have symptoms or your symptoms are mild, medicines and changes to your daily habits may be enough. But your provider will keep a close eye on your condition and recommend further treatment as needed. If you have severe symptoms or are at risk of losing a limb, you’ll need a procedure or surgery.

Medication

Medicines for peripheral artery disease include:

• Blood thinners: These lower your risk of blood clots. Your provider may prescribe an antiplatelet drug like clopidogrel or aspirin. They may prescribe a low dose of rivaroxaban, too.
• Vasodilators: These help your arteries open up better so blood can flow through. This can let you walk farther without leg pain. Cilostazol is an example of a medicine your provider might prescribe.
• Statins: These reduce your LDL cholesterol level. A lower LDL helps protect you from limb loss and death from cardiovascular disease.
• Blood pressure medicines: These lower your risk of heart attack, stroke, heart failure and death.
• Medications to quit smoking: If you currently smoke and have PAD, quitting is one of the best ways to reduce the risk of it progressing to limb loss. Your provider may prescribe medicines to help you do this.

Changes to your daily habits

Your healthcare provider may recommend you:

• Exercise: Structured exercise therapy (SET) is a key part of treating PAD. A healthcare provider plans and supervises routine sessions. You walk on a treadmill and take breaks when your legs hurt. This is usually the most helpful form of exercise for people with PAD.
• Eat heart-healthy foods: The Mediterranean Diet and DASH diet can help you manage PAD risk factors. Aim for plenty of veggies, fruits, nuts, whole grains and legumes.
• Stop smoking: Again, this is one of the most important things you can do to manage PAD. Your provider will help you make a plan for quitting. It might include things like nicotine replacement therapy, counseling and referral to a smoking cessation program.

Foot care

Taking good care of your feet is crucial with PAD. You should:

• Check your feet daily for signs of cracks or ulcers
• Wash and dry your feet every day to protect your skin
• Avoid walking barefoot
• Wear socks and shoes that fit well

Your provider can give you more advice, too. It’s important to know that wounds that develop have a more difficult time healing. And infections are difficult to clear when there’s reduced blood flow to your foot.

Procedures and surgeries

If other treatments don’t help enough or PAD grows severe, you may need a procedure or surgery. Examples include:

• Angioplasty: This procedure makes more space in your artery to help blood flow through. A provider inflates a tiny balloon to push plaque aside. They may also insert a stent to keep your artery open.
• Atherectomy: A provider uses a thin tube (catheter) to reach the affected artery and remove plaque. This is a minimally invasive procedure.
• Endarterectomy: This is the surgical removal of plaque.
• Peripheral artery bypass surgery: A provider makes a new route for blood to flow around the narrowed or blocked part of your artery.

What can I expect if I have this condition?

When you’re living with PAD, you can expect to have frequent follow-up appointments with your provider. These are key to catching signs of problems that need prompt treatment.

Peripheral artery disease is a lifelong condition. Although there’s no cure, you can keep it from getting worse by:

• Taking your medicines
• Doing a supervised exercise program and other physical activity as your provider recommends
• Not smoking or being around secondhand smoke
• Eating nutritious foods
• Managing risk factors like diabetes, high cholesterol and high blood pressure

Quitting smoking is one of the best things you can do to improve your life expectancy. About 86 in 100 people who quit smoking after their PAD diagnosis live at least five more years. Of those who continue smoking, only 69 in 100 live at least five more years.