Peripheral Artery Disease: Causes, Symptoms & Treatment

Peripheral artery disease (PAD) is a circulatory condition in which narrowed arteries reduce blood flow to the limbs, most commonly the legs. Like coronary artery disease, PAD is caused by atherosclerosis -- the buildup of fatty plaque in the artery walls. PAD is both a local problem causing leg symptoms and a marker of widespread atherosclerosis that significantly increases the risk of heart attack and stroke.

PAD affects approximately 8 to 12 million Americans and more than 200 million people worldwide. It is particularly common in people over 65 and in those who smoke or have diabetes.

Many people with PAD have no symptoms or attribute their symptoms to aging. The hallmark symptom is:

Intermittent claudication:

• Muscle pain, cramping, or aching in the calves, thighs, or hips during walking or climbing stairs
• Pain that reliably occurs after a certain walking distance
• Pain that resolves with 2-5 minutes of rest
• Pain that returns when walking is resumed

More advanced symptoms:

• Foot or toe pain at rest, especially at night
• Non-healing wounds or sores on the feet or toes
• Coldness or color changes in the affected leg or foot
• Weak or absent pulses in the legs or feet
• Shiny skin, hair loss, or thickened toenails on affected limbs
• Gangrene (tissue death) in severe cases

• Ankle-brachial index (ABI): The primary screening test -- compares blood pressure in the ankle to that in the arm. An ABI of 0.90 or less indicates PAD
• Duplex ultrasound: Images blood flow and identifies the location and severity of blockages
• CT angiography or MR angiography: Detailed imaging of the arterial tree for surgical planning
• Angiography: Invasive catheter-based imaging, often combined with treatment

Lifestyle modifications (essential for all patients):

• Smoking cessation (most important modifiable risk factor)
• Supervised exercise therapy: structured walking programs for 30-45 minutes, 3 times per week, for at least 12 weeks -- this is one of the most effective treatments for claudication
• Heart-healthy diet

Medications:

• Antiplatelet therapy (aspirin or clopidogrel) to reduce cardiovascular events
• Statins to lower cholesterol and stabilize plaque
• Blood pressure medications (target below 130/80)
• Diabetes management (HbA1c target individualized, generally below 7%)
• Cilostazol for claudication symptom relief

Procedures (for severe or lifestyle-limiting disease):

• Angioplasty and stenting (balloon dilation of narrowed arteries)
• Atherectomy (removal of plaque)
• Bypass surgery (grafting a new blood vessel to reroute blood around the blockage)

• Do not smoke
• Exercise regularly
• Control blood pressure, cholesterol, and blood sugar
• Maintain a healthy weight
• Inspect feet daily if you have diabetes or PAD

See a doctor if you experience leg pain when walking that resolves with rest, numbness or weakness in your legs, coldness in your lower leg or foot, or non-healing sores on your toes or feet.