What Is Peripheral Artery Disease?

Definition

Peripheral artery disease (PAD) happens when arteries become narrowed or blocked and blood flow is reduced. It most commonly affects the legs and feet. PAD affects 6.5 million people over the age of 40 in the U.S.

Peripheral arteries are the blood vessels that carry oxygenated blood from the heart to the rest of the body. Cholesterol plaques can form and build up in these arteries, causing them to narrow. This process — atherosclerosis — is the primary cause of PAD. 

The most common type of PAD involves the arteries of the legs and feet. But cholesterol can build up in any blood vessel. 

PAD is similar to coronary artery disease (CAD), where atherosclerosis affects the arteries that supply the heart muscle.

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Causes

Smoking is the most common cause of PAD. People who smoke are 2 to 4 times more likely to develop PAD than people who don’t smoke. But there are many other factors that can lead to PAD, including:

• Type 2 diabetes

• Older age

• High blood pressure

• High cholesterol

• Family history of PAD

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Symptoms

Symptoms of PAD of the lower limbs can depend on how narrowed or blocked the arteries become:

• In the first stages of PAD, people might have no symptoms.

• In the second stages of PAD, people can have tiredness, aching, or cramping in the calves, thighs, hips, or buttocks when walking, especially up hills. This symptom is called “claudication.” 

• In later stages of PAD, people can have pain and color changes in the legs and toes, even while resting. They can go on to develop skin wounds or gangrene of the toes and feet.

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Diagnosis

PAD diagnosis begins with telling your healthcare provider about your symptoms. They’ll ask you for details, including if your symptoms get worse when you walk. They’ll then do a physical examination. This includes feeling the pulses in your legs and feet and looking at your skin for ulcers or infections. 

If they suspect you have PAD, they may order some additional testing, including:

• Ankle-brachial index (ABI): This index compares blood pressure measurements from the arms and the legs.

• Ultrasound: This test uses sound waves to look at blood flow in blood vessels and detect blockages.

• CT or MRI angiography: These tests provide specialized pictures of the leg arteries after someone receives contrast dye to look for blockages.

• Angiography: A vascular specialist injects dye into the arteries and takes pictures of the leg arteries using X-rays. They may also treat the blockages during the same procedure.

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Medications

Treating and preventing PAD involves taking steps to improve your overall health. This includes quitting smoking, improving your diet, and starting an exercise program your healthcare provider supervises. Increasing how much you walk can improve blood flow to the legs and feet, and it can help the pain PAD causes. 

Healthcare providers may prescribe medications to treat and reduce symptoms of PAD. These include:

• Antiplatelet agents: These prevent blood clots from forming in arteries that are already narrowed by PAD. Examples include:

  • Aspirin

  • Clopidogrel (Plavix)

• Cholesterol-lowering medications: These reduce plaque buildup and lower the risk of complications of PAD. Examples include:

  • Atorvastatin (Lipitor)

  • Rosuvastatin (Crestor)

  • Simvastatin (Zocor)

• Cilostazol: Cilostazol (Pletal) prevents blood clots and expands the blood vessels, which can reduce symptoms.

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Procedures

Sometimes lifestyle changes and medications are not enough to treat the symptoms of PAD. Your provider may refer you to a vascular specialist. They perform procedures that open up the blockages and improve blood flow. These procedures include:

• Angioplasty/stent placement: The specialist inflates a small balloon in the artery to open it up. They may also place a stent, a metal mesh tube that keeps the artery open.

• Atherectomy: A special device shaves away the cholesterol plaque from the walls of the arteries.

• Bypass surgery: A surgeon attaches a vein from another part of the body to the artery to redirect the blood around the blockage.

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Prevention

You can prevent PAD and reduce its symptoms with healthy lifestyle habits. These include:

• Not smoking: Avoiding smoking decreases PAD symptoms or prevents them altogether.

• Exercising regularly: This increases blood flow to the legs and feet and reduces symptoms of PAD.

• Losing weight: Weight loss improves overall health and reduces risk factors for PAD, such as diabetes and high blood pressure.

• Eating a low-sodium, low-fat diet: This diet lowers blood pressure and cholesterol, which can reduce the risk of PAD.

These lifestyle changes may sound familiar to you. They’re similar to those recommended for people with coronary artery disease, high blood pressure, strokes, and diabetes. For all of these conditions, it’s also important to get other medical issues under better control. This will help reduce your risk of developing complications such as amputation, heart attack, or stroke

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