Introduction

Peripheral artery disease (P.A.D.) is due to plaque buildup in the arteries that carry blood to your head, organs, and limbs. Plaque is made up of fat, cholesterol, calcium, fibrous tissue, and other substances in the blood.

When plaque builds up in the body’s arteries, the condition is called atherosclerosis. Over time, plaque can harden and narrow the arteries. This limits the flow of oxygen-rich blood to your organs and other parts of your body.

P.A.D. usually affects the arteries in the legs, but it also can affect the arteries that carry blood from your heart to your head, arms, kidneys, and stomach. We will here focus on P.A.D. that affects blood flow to the legs.


Normal Artery and Artery With Plaque Buildup

The illustration shows how P.A.D. can affect arteries in the legs. Figure A shows a normal artery with normal blood flow. The inset image shows a cross-section of the normal artery. Figure B shows an artery with plaque buildup partially blocking blood flow. The inset image shows a cross-section of the narrowed artery.

Overview

Blocked blood flow to your legs can cause pain in your muscles on walking and numbness in your feet and toes. It also can raise your risk of getting an infection in the affected limbs. Your body may have a hard time fighting the infection.

If severe enough, blocked blood flow can cause gangrene (tissue death). In very serious cases, this can lead to leg amputation.

If you have leg pain when you walk or climb stairs, talk with your doctor. Sometimes older people think that leg pain is just a symptom of aging. However, the cause of the pain could be P.A.D. Tell your doctor if you’re feeling pain in your legs and discuss whether you should be tested for P.A.D. and referred to a Vascular Surgeon.

Smoking is the main risk factor for P.A.D. If you smoke or have a history of smoking, your risk of P.A.D. increases. Other factors, such as age and having certain diseases or conditions, also increase your risk of P.A.D.

Outlook

P.A.D. increases your risk of coronary heart disease, heart attack, stroke, and transient ischemic attack (“mini-stroke”). Although P.A.D. is serious, it’s treatable. If you have the disease, see your doctor regularly and treat the underlying atherosclerosis. P.A.D. treatment may slow or stop disease progress and reduce the risk of complications. Treatments include lifestyle changes, medicines, and surgery or procedures. Researchers continue to explore new therapies for P.A.D.

Causes

The most common cause of peripheral artery disease (P.A.D.) is atherosclerosis. Atherosclerosis is a disease in which plaque builds up in your arteries. The exact cause of atherosclerosis isn’t known.

The disease may start if certain factors damage the inner layers of the arteries. These factors include:

  • Smoking
  • High amounts of certain fats and cholesterol in the blood
  • High blood pressure
  • High amounts of sugar in the blood due to insulin resistance or diabetes

When damage occurs, your body starts a healing process. The healing may cause plaque to build up where the arteries are damaged.

Eventually, a section of plaque can rupture (break open), causing a blood clot to form at the site. The buildup of plaque or blood clots can severely narrow or block the arteries and limit the flow of oxygen-rich blood to your body.

Risk Factors

Peripheral artery disease (P.A.D.) affects millions of people in the United States. The disease is more common in blacks than any other racial or ethnic group. The major risk factors for P.A.D. are smoking, older age, and having certain diseases or conditions.

Smoking

Smoking is the main risk factor for P.A.D. and your risk increases if you smoke or have a history of smoking. Quitting smoking slows the progress of P.A.D. People who smoke and people who have diabetes are at highest risk for P.A.D. complications, such as gangrene (tissue death) in the leg from decreased blood flow.

Older Age

Older age also is a risk factor for P.A.D. Plaque builds up in your arteries as you age. Older age combined with other risk factors, such as smoking or diabetes, also puts you at higher risk for P.A.D.

Diseases and Conditions

Many diseases and conditions can raise your risk of P.A.D., including:

  • Diabetes
  • High blood pressure
  • High blood cholesterol
  • Coronary heart disease
  • Stroke
  • Metabolic syndrome

Prevention

Taking action to control your risk factors can help prevent or delay peripheral artery disease (P.A.D.) and its complications. Know your family history of health problems related to P.A.D. If you or someone in your family has the disease, be sure to tell your doctor.

Controlling risk factors includes the following.

  • Be physically active.
  • Be screened for P.A.D. A simple office test, called an ankle-brachial index or ABI, can help determine whether you have P.A.D.
  • Follow heart-healthy eating.
  • If you smoke, quit. Talk with your doctor about programs and products that can help you quit smoking.
  • If you’re overweight or obese, work with your doctor to create a reasonable weight-loss plan.

The lifestyle changes described above can reduce your risk of developing P.A.D. These changes also can help prevent and control conditions that can be associated with P.A.D., such as coronary heart disease, diabetes, high blood pressure, high blood cholesterol, and stroke.

Clinical Features

Many people who have peripheral artery disease (P.A.D.) don’t have any signs or symptoms.

Even if you don’t have signs or symptoms, ask your doctor whether you should get checked for P.A.D. if you’re:

  • Aged 70 or older
  • Aged 50 or older and have a history of smoking or diabetes
  • Younger than 50 and have diabetes and one or more risk factors for atherosclerosis

Intermittent Claudication

People who have P.A.D. may have symptoms when walking or climbing stairs, which may include pain, numbness, aching, or heaviness in the leg muscles. Symptoms also may include cramping in the affected leg(s) and in the buttocks, thighs, calves, and feet. Symptoms may ease after resting. These symptoms are called intermittent claudication.

During physical activity, your muscles need increased blood flow. If your blood vessels are narrowed or blocked, your muscles won’t get enough blood, which will lead to symptoms. When resting, the muscles need less blood flow, so the symptoms will go away.

Other Signs and Symptoms

Other signs and symptoms of P.A.D. include:

  • Weak or absent pulses in the legs or feet
  • Sores or wounds on the toes, feet, or legs that heal slowly, poorly, or not at all
  • A pale or bluish color to the skin
  • A lower temperature in one leg compared to the other leg
  • Poor nail growth on the toes and decreased hair growth on the legs
  • Erectile dysfunction, especially among men who have diabetes

Diagnosis

Peripheral artery disease (P.A.D.) is diagnosed based on your medical and family histories, a physical exam, and test results.

P.A.D. often is diagnosed after symptoms are reported. A correct diagnosis is important because people who have P.A.D. are at higher risk for coronary heart disease (CHD), heart attack, stroke, and transient ischemic attack (“mini-stroke”). If you have P.A.D., your doctor also may want to check for signs of these diseases and conditions.

Diagnostic Tests

Ankle-Brachial Index

A simple test called an ankle-brachial index (ABI) often is used to diagnose P.A.D. The ABI compares blood pressure in your ankle to blood pressure in your arm. This test shows how well blood is flowing in your limbs.

ABI can show whether P.A.D. is affecting your limbs, but it won’t show which blood vessels are narrowed or blocked.

A normal ABI result is 1.0 or greater (with a range of 0.90 to 1.30). The test takes about 10 to 15 minutes to measure both arms and both ankles. This test may be done yearly to see whether P.A.D. is getting worse.

Ankle-Brachial Index

The illustration shows the ankle-brachial index test. The test compares blood pressure in the ankle to blood pressure in the arm. As the blood pressure cuff deflates, the blood pressure in the arteries is recorded.

Doppler Ultrasound

A Doppler ultrasound looks at blood flow in the major arteries and veins in the limbs. During this test, a handheld device is placed on your body and passed back and forth over the affected area. A computer converts sound waves into a picture of blood flow in the arteries and veins.

The results of this test can show whether a blood vessel is blocked. The results also can help show the severity of P.A.D.

Treadmill Test

A treadmill test can show the severity of symptoms and the level of exercise that brings them on. You’ll walk on a treadmill for this test. This shows whether you have any problems during normal walking.

You may have an ABI test before and after the treadmill test. This will help compare blood flow in your arms and legs before and after exercise.

Computerised Tomographic Angiogram (CT Scan)

Computed tomography angiography (CTA) uses an injection of iodine-rich contrast material and CT scanning to help diagnose and evaluate blood vessel disease or related conditions, such as aneurysms or blockages. CT angiography uses a CT scanner to produce detailed images of both blood vessels and tissues in various parts of the body. An iodine-rich contrast material (dye) is usually injected through a small catheter placed in a vein of the arm. A CT scan is then performed while the contrast flows through the blood vessels to the various organs of the body. After scanning, the images will be processed using a special computer and software and reviewed in different planes and projections which help vascular surgeons to assess the severity of your disease as well as plan treatment.

Arteriogram / Angiogram

An arteriogram provides a “road map” of the arteries. Vascular surgeon uses this test to find the exact location of a blocked artery.

For this test, dye is injected through a needle or catheter (tube) into one of your arteries. This may make you feel mildly flushed. After the dye is injected, an x ray is taken. The x ray can show the location, type, and extent of the blockage in the artery.

Blood Tests

Your doctor may recommend blood tests to check for P.A.D. risk factors. For example, blood tests can help diagnose conditions such as diabetes and high blood cholesterol.

Treatment

Treatments for peripheral artery disease (P.A.D.) include heart-healthy lifestyle changes, medicines, and surgery or procedures.

The overall goals of treating P.A.D. include reducing risk of heart attack and stroke; reducing symptoms of claudication; improving mobility and overall quality of life; and preventing complications. Treatment is based on your signs and symptoms, risk factors, and the results of physical exams and tests.

Treatment may slow or stop the progression of the disease and reduce the risk of complications. Without treatment, P.A.D. may progress, resulting in serious tissue damage in the form of sores or gangrene (tissue death) due to inadequate blood flow. In extreme cases of P.A.D., also referred to as critical limb ischemia (CLI), removal (amputation) of part of the leg or foot may be necessary.

Heart-Healthy Lifestyle Changes

Treatment often includes making life-long heart-healthy lifestyle changes such as:

  • Physical activity
  • Quitting smoking
  • Heart-healthy eating
  • Surgery or Procedures

Bypass Grafting

Your doctor may recommend bypass grafting surgery if blood flow in your limb is blocked or nearly blocked. For this surgery, your doctor uses a blood vessel from another part of your body or a synthetic tube to make a graft.

This graft bypasses (that is, goes around) the blocked part of the artery. The bypass allows blood to flow around the blockage. This surgery doesn’t cure P.A.D., but it may increase blood flow to the affected limb.

Angioplasty and Stent Placement

Your doctor may recommend angioplasty to restore blood flow through a narrowed or blocked artery.

During this procedure, a catheter (thin tube) with a balloon at the tip is inserted into a blocked artery. The balloon is then inflated, which pushes plaque outward against the artery wall. This widens the artery and restores blood flow.

A stent (a small mesh tube) may be placed in the artery during angioplasty. A stent helps keep the artery open after angioplasty is done. Some stents are coated with medicine to help prevent blockages in the artery.

Atherectomy

Atherectomy is a procedure that removes plaque buildup from an artery. During the procedure, a catheter is used to insert a small cutting device into the blocked artery. The device is used to shave or cut off plaque.

The bits of plaque are removed from the body through the catheter or washed away in the bloodstream (if they’re small enough).

Other Types of Treatment

Researchers are studying cell and gene therapies to treat P.A.D. However, these treatments aren’t yet available outside of clinical trials.

Living With Peripheral Artery Disease Symptoms

If you have P.A.D., you may feel pain in your calf or thigh muscles after walking. Try to push as far as you can tolerate the pain and then take a break and allow the pain to ease before walking again. Over time, this may increase the distance that you can walk without pain.

Talk with your doctor about taking part in a supervised exercise program. This type of program has been shown to reduce P.A.D. symptoms.

Check your feet and toes regularly for sores or possible infections. Wear comfortable shoes that fit well. Maintain good foot hygiene and have professional medical treatment for corns, bunions, or calluses.

Ongoing Health Care Needs and Lifestyle Changes

See your doctor for checkups as he or she advises. If you have P.A.D. without symptoms, you still should see your doctor regularly. Take all medicines as your doctor prescribes.

Heart-healthy lifestyle changes can help prevent or delay P.A.D. and other related problems, such as coronary heart disease, heart attack, stroke, and transient ischemic attack. Heart-healthy lifestyle changes include physical activity, quitting smoking, and heart-healthy eating.