Peripheral Artery Disease and How It's Treated

Peripheral artery disease (PAD) is a condition in which one or more of the arteries supplying blood to the body, flowing away from the heart, become blocked or partially blocked. This often reduces blood flow to your legs or feet, but it can affect your arms as well.

PAD is common and affects about 10 million people over age 40 in the United States. Early symptoms can include cold feet and leg cramping with activity, although some people with PAD don't experience symptoms. Advanced disease can cause constant pain and tissue death. Treatments are available, so talk to your healthcare provider about a diagnosis.

Symptoms

PAD occurs when blood flow is reduced due to plaque, or fatty deposits, that causes a narrowing of arteries (atherosclerosis). It most often affects the legs and causes claudication, or leg pain when walking. Symptoms also include:

• Fatigue
• Cramping
• General discomfort

The claudication symptoms usually improve within 10 minutes of rest, but they are considered a chronic condition. Symptoms can worsen without treatment or as the disease progresses. Pain can become constant and affect your quality of life and function.

Other symptoms of PAD can include:

• Pale or bluish skin tone caused by poor blood flow
• Hair thinning on an affected arm or leg
• Changes to toenails (brittle, slow to grow)
• Wound and ulcers that don't heal well
• Erectile dysfunction

People with symptoms in the arm or shoulder can experience the same type of fatigue, numbness, and muscle pain or weakness. Some can even experience neurological symptoms with subclavian steal syndrome, a condition associated with atherosclerosis of the subclavian or other nearby arteries affecting the chest and arm.

Causes and Risk Factors

In the large majority of cases, PAD is caused by atherosclerosis. Risk factors include:

• Age: Older people are more at risk of PAD.
• Race and ethnicity: Black people have a higher incidence than other groups.
• Medical conditions: Co-occurring health conditions can contribute to the risk of PAD. They include diabetes and stroke, as well as high blood pressure and high cholesterol.
• Lifestyle factors: Smoking, poor diet, and lack of exercise can affect your risk.

PAD also is more likely to affect males, and females after menopause.

More rarely, PAD can have other causes including exposure to radiation during cancer treatment, as well as conditions like fibromuscular dysplasia and vasculitis.

Diagnosis

A diagnosis of PAD includes careful examination and evaluation of your family and health history. Tests used to diagnose PAD include:

• The ankle-brachial index, or ABI. The blood pressure is measured and compared in the ankle and the arm.
• Exercise treadmill test, or an alternative for people who can't use treadmills
• Plethysmography (blood pressure readings) and pulse volume recordings to measure blood flow
• Computed tomography angiography
• Duplex ultrasound

Treatment

While mild or moderate PAD can be treated with medication and lifestyle changes, more severe cases often require procedures to remove the blockages.

Treatment can include:

• Medications to control blood pressure and cholesterol
• Medications to improve the ability to walk, like Pletal (cilostazol)
• Blood thinners such as Plavix (clopidogrel)
• Foot and wound care, especially with a diabetes history
• Physical therapy and exercise programs to relieve claudication symptoms

For more severe cases, your healthcare provider may recommend procedures or surgery to restore blood flow, including:

• Balloon angioplasty
• Laser angioplasty
• Laser atherectomy
• Bypass surgery

The placement of a stent, a mesh device to keep the blood vessel open, is common with angioplasty.

Complications

Among those diagnosed with PAD, people who smoke or have diabetes are most at risk for complications. More severe pain and worsening mobility problems are common.

Some people develop critical limb ischemia, a more serious form of PAD that causes increased blood flow issues. Complications can lead to gangrene infection or limb loss (amputation).

Stroke is more likely to occur in those with PAD than among healthy people. PAD also can co-occur with mental health issues and complications, including depression.

Prevention

There are some risk factors for peripheral artery disease, like a family history of cardiovascular risk, that can't be changed. But you can improve your chances with lifestyle changes that include:

• Losing weight (obesity is a risk factor)
• Getting exercise, especially walking programs to increase the distance you can walk
• Taking medication to manage health conditions like high blood pressure, high cholesterol, diabetes, kidney problems, and other conditions that can affect PAD
• Following a heart-healthy diet with more fresh fruit and vegetables, less meat and fat
• Limiting your alcohol intake

Smoking is another preventable risk factor for PAD. Talk with your healthcare provider about ways to quit if tobacco use is part of your health history.

Summary

Peripheral artery disease (PAD) is a condition caused by plaque buildup and atherosclerosis, a narrowing of the arteries that impedes blood flow to the legs or arms. It is most often due to high cholesterol, high blood pressure and other heart health factors.

There is no cure and complications of PAD can be serious and potentially fatal. Medication, surgery, and other treatments are available to extend and improve quality of life. Talk with your healthcare provider about pain, trouble walking, and other symptoms that may require diagnosis and care.