Peripheral Arterial Disease

Peripheral artery disease (PAD) is a common condition in which narrowed arteries reduce blood flow to the arms or legs.

This condition also may be called peripheral arterial disease.

In PAD, the legs or arms — usually the legs — don’t get enough blood flow to keep up with demand. This may cause leg pain when walking, called claudication, and other symptoms.

Peripheral artery disease is usually a sign of a buildup of fatty deposits in the arteries, a condition called atherosclerosis.

Treatment for PAD includes exercising, eating healthy foods, and not smoking or using tobacco.

Symptoms

Peripheral artery disease (PAD) may not cause symptoms, or symptoms may be mild. PAD symptoms include:

• Leg pain when walking.
• Muscle pain or cramping in the arms or legs, often in the calf.
• Muscle pain in the arms or legs that begins with exercise and ends with rest.
• Painful cramping in one or both of the hips, thighs or calves after walking or climbing stairs or other activities.
• Pain when using the arms, such as aching and cramping when knitting or writing.
• Coldness in the lower leg or foot, especially when compared with the other side.
• Leg numbness or weakness.
• No pulse or a weak pulse in the legs or feet.

The muscle pain in peripheral artery disease may:

• Be mild to extreme.
• Wake you up from sleep.
• Make it hard to walk or exercise.
• Occur during rest or when lying down if the condition is severe.

Other symptoms of PAD may include:

• Shiny skin on the legs.
• Skin color changes on the legs.
• Slow-growing toenails.
• Sores on the toes, feet or legs that won’t heal.
• Hair loss or slower hair growth on the legs.
• Erectile dysfunction.

When to see a doctor

Make an appointment for a health checkup if you have leg or arm pain or other symptoms of peripheral artery disease.

Causes

Peripheral artery disease (PAD) is often caused by a buildup of fats, cholesterol and other substances in and on the artery walls, a condition called atherosclerosis. The buildup is called plaque. Plaque can cause arteries to narrow, blocking blood flow. In PAD, plaque collects in the arteries of the arms or legs.

Less common causes of PAD include:

• Swelling and irritation of blood vessels.
• Injury to the arms or legs.
• Changes in the muscles or ligaments.
• Radiation exposure.

Risk factors

Risk factors for peripheral artery disease (PAD) include:

• A family history of peripheral artery disease, heart disease or stroke.
• Diabetes.
• High blood pressure.
• High cholesterol.
• Increasing age, especially after 65, or after 50 if you have risk factors for atherosclerosis.
• Obesity.
• Smoking.

Complications

Complications of peripheral artery disease (PAD) caused by atherosclerosis include:

• Critical limb ischemia. In this condition, an injury or infection causes tissue to die. Symptoms include open sores on the limbs that don’t heal. Treatment may include amputation of the affected limb.
• Stroke and heart attack. Plaque buildup in the arteries also can affect the blood vessels in the heart and brain.

Prevention

The best way to prevent leg pain due to peripheral artery disease (PAD) is to have a healthy lifestyle. That means:

• Don’t smoke.
• Eat foods that are low in sugar, trans fats and saturated fats.
• Get regular exercise — but check with your care team about what type and how much is best for you.
• Keep a healthy weight.
• Manage blood pressure, cholesterol and diabetes.
• Get good sleep.
• Control stress.

Diagnosis

To diagnose peripheral artery disease (PAD), a healthcare professional examines you. You are usually asked questions about your symptoms and medical history.

If you have peripheral artery disease, the pulse in the affected area may be weak or missing.

Tests

Tests to diagnose peripheral artery disease (PAD) or check for conditions that cause it may include:

• Blood tests. Blood tests are done to check for things that increase the risk of PAD, such as high cholesterol and high blood sugar.
• Ankle-brachial index (ABI). This is a common test used to diagnose PAD. It compares the blood pressure in the ankle with the blood pressure in the arm. You may be asked to walk on a treadmill. Blood pressure readings may be taken before and right after exercising to check the arteries during walking.
• Ultrasound of the legs or feet. Sound waves create pictures of how blood moves through the blood vessels of the legs or feet. Doppler ultrasound is a special type of ultrasound used to spot blocked or narrowed arteries.
• Angiography. This test uses imaging tests and a dye to look for blockages in the arteries. The dye is given through a blood vessel. It helps the arteries show up more clearly on the test images.

Treatment

The goals of treatment for peripheral artery disease (PAD) are:

• Manage symptoms, such as leg pain, so exercise is comfortable.
• Improve artery health to reduce the risk of heart attack, stroke and other complications.

Treatment for peripheral artery disease may include:

• Lifestyle changes.
• Medicine.
• Surgery.

Lifestyle changes can help improve symptoms, especially if you have early peripheral artery disease. Such changes include:

• Don’t smoke or use tobacco.
• Get regular exercise.
• Eat a healthy diet.

Medications

If you have symptoms or complications of peripheral artery disease (PAD), you may need medicines.

Medicine to treat peripheral artery disease may include:

• Statins. These are medicines to lower “bad” cholesterol. They help reduce plaque buildup in the arteries. The drugs also lower the risk of heart attacks and strokes.
• Blood pressure medicines. Uncontrolled high blood pressure can make arteries stiff and hard. This can slow the flow of blood. If you have high blood pressure, your healthcare professional may suggest medicines to control it. Ask your healthcare team what your blood pressure should be.
• Diabetes medicine. Diabetes makes you more likely to get PAD. Talk with your healthcare team about your blood sugar goals and how to reach them.
• Medicines to prevent blood clots. Reduced blood flow in PAD can cause blood clots. Aspirin or another medicine, such as clopidogrel (Plavix), may be used to prevent blood clotting.
• Leg pain medicine. A medicine called cilostazol can be used to treat leg pain in people with peripheral artery disease. The medicine increases blood flow to the area.

Sometimes, a surgery or procedure is needed to treat peripheral artery disease (PAD) or its symptoms.

• Thrombolytic therapy. If a blood clot is blocking an artery, medicine may be given directly into the affected artery to dissolve the clot.
• Angioplasty and stent placement. If a narrowed artery is causing PAD leg pain, this treatment may help. A tiny balloon on a tube, called a catheter, is placed in the artery. The balloon inflates, which makes the artery wider. This improves blood flow. A small wire mesh tube, called a stent, may be placed in the artery to keep the artery open.
• Bypass surgery. This surgery creates a new path for blood to flow around a blocked or partially blocked artery. A surgeon takes a healthy blood vessel from another part of the body. The vessel is connected below the blocked artery. The new pathway improves blood flow to the muscle.