Cardiovascular Institute > About Us > Conditions > Peripheral Artery Disease

Peripheral Artery Disease

Peripheral artery disease (PAD) is a slow and progressive circulation disorder caused by narrowing, blockage or spasms in a blood vessel.

PAD may involve disease in any of the blood vessels outside of the heart including the arteries, veins or lymphatic vessels. Organs supplied by these vessels, such as the brain, and legs, may not get enough blood flow for proper function. However, the legs and feet are most commonly affected, thus the name peripheral vascular disease.

The terms "peripheral arterial disease" and "peripheral vascular disease" are often used to describe the same condition.

Causes

PAD is often characterized by a narrowing of the vessels that carry blood to the leg and arm muscles. The most common cause is atherosclerosis, the buildup of plaque inside the artery wall. Plaque reduces the amount of blood flow to the limbs and decreases the oxygen and nutrients available to the tissue. Clots may form on the artery walls, further decreasing the inner size of the vessel and potentially blocking off major arteries.

Other causes of peripheral vascular disease include:

  • Injury to the arms or legs
  • Irregular anatomy of muscles or ligaments
  • Infection

Risk Factors

  • Age (older than age 50)
  • Coronary artery disease
  • Diabetes
  • High blood sugar
  • High cholesterol
  • High blood pressure
  • History of heart disease
  • Family history
  • Male gender
  • Obesity
  • Physical inactivity
  • Postmenopausal women
  • Smoking or use of tobacco products

Symptoms

Approximately half the people diagnosed with peripheral vascular disease are symptom free. For those experiencing symptoms, the most common first symptom is intermittent claudication in the calf (leg discomfort described as painful cramping that occurs with exercise and is relieved by rest).

Other symptoms may include:

  • Changes in skin, including decreased skin temperature or thin, brittle, shiny skin on the legs and feet
  • Diminished pulses in legs and feet
  • Gangrene
  • Hair loss on legs
  • Impotence
  • Non-healing wounds over pressure points, such as heels or ankles
  • Numbness, weakness or heaviness in muscles
  • Pain (described as burning or aching) at rest, commonly in the toes and at night while lying flat
  • Pallor (paleness) when legs are elevated
  • Reddish-blue discoloration of the extremities
  • Restricted mobility
  • Severe pain when the narrowing of the artery is significant or totally blocked
  • Thickened, opaque toenails

Diagnosis

In addition to a complete medical history and physical exam, other tests may include:

  • Angiogram: An X-ray of the arteries and veins to detect blockage or narrowing of the vessels
  • Ankle-brachial index (ABI): A comparison of the blood pressure in the ankle with the blood pressure in the arm using a regular blood pressure cuff and a Doppler ultrasound device
  • Doppler ultrasound flow studies: An ultrasound of blood vessels, tissues, organs and blood flow.
  • Magnetic resonance angiography (MRA): A non-invasive diagnostic procedure to produce detailed images of organs and structures within the body.
  • Treadmill exercise test: Patient walks on a treadmill to monitor circulation during exercise
  • Photoplethysmography (PPG): A very tiny blood pressure cuff around the toe and a PPG sensor record waveforms and blood pressure measurements
  • Pulse volume recording (PVR) waveform analysis: A recording of blood volume changes in the legs
  • Reactive hyperemia test: Comparative blood pressure measurements are taken on thighs and ankles while patient is lying on his or her back

Treatment

The main goals for treatment of peripheral artery disease are to control the symptoms and halt the progression of the disease. Options include:

  • Lifestyle changes to control risk factors, including regular exercise, proper nutrition and smoking cessation
  • Aggressive treatment of existing conditions that may worsen PAD, such as diabetes, high blood pressure and high cholesterol
  • Medications for improving blood flow
  • Vascular surgery — a bypass graft placed in the area of the blocked or narrowed artery to reroute blood flow
  • Angioplasty — a catheter (long, hollow tube) used to create a larger opening in an artery to increase blood flow

Complications

Complications of peripheral artery disease most often occur because of decreased or absent blood flow. Such complications may include:

  • Amputation (loss of a limb)
  • Poor wound healing
  • Restricted mobility due to pain or discomfort with exertion
  • Severe pain in the affected extremity
  • Stroke (three times more likely in people with PAD)

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