Peripheral Arterial Disease (PAD)
What is peripheral arterial disease?
Peripheral arterial disease (PAD) is a circulatory condition in which narrowed arteries reduce blood flow to the limbs, most often the legs. It is usually caused by atherosclerosis, the buildup of plaque in artery walls. Reduced blood flow can lead to leg pain when walking, numbness, coldness, non-healing sores, and color changes in the legs. Some people have no symptoms.
What causes PAD?
The primary cause is atherosclerosis, but several factors increase risk:
- Smoking, which damages and narrows arteries
- Diabetes, leading to vessel injury and plaque buildup
- High blood pressure, which strains arterial walls
- High cholesterol, promoting plaque formation
- Age over 50 years
- Family history of PAD, heart disease, or stroke
- Obesity, which worsens other risk factors
What are the symptoms?
Intermittent claudication
Leg pain, cramping, or discomfort when walking that resolves with rest, typically affecting the calves.
Other signs
- Numbness or weakness in the legs
- Coldness in the lower leg or foot compared to the other side
- Sores on toes, feet, or legs that fail to heal
- Change in leg skin color or hair loss on legs
- Shiny skin on the legs and slower toenail growth
- Erectile dysfunction in men with diabetes
- Rest pain in severe cases, possibly leading to critical limb ischemia and gangrene
How is PAD diagnosed?
- Ankle-Brachial Index (ABI): Compares ankle and arm blood pressures to detect reduced leg blood flow.
- Doppler ultrasound: Visualizes blood flow and identifies blockages.
- Treadmill ABI test: ABI measured before and after exercise if resting ABI is normal.
- Angiography: Contrast-enhanced MRI, CT, or X-ray to map arterial blockages.
- Blood tests: Assess related conditions (diabetes, cholesterol).
How is PAD treated?
Lifestyle changes
- Quit smoking to halt arterial damage
- Supervised walking program to improve circulation
- Heart-healthy diet to lower cholesterol and blood pressure
- Weight management to reduce cardiovascular strain
Medications
- Antiplatelet agents (aspirin, clopidogrel) to prevent clots
- Statins to lower cholesterol and stabilize plaques
- Blood pressure medications (ACE inhibitors, ARBs)
- Cilostazol or pentoxifylline to improve walking distance
Interventional procedures
- Angioplasty with stent placement to open narrowed arteries
- Atherectomy to remove arterial plaque
- Bypass surgery to reroute blood flow around blockages
Monitoring
Regular follow-up with ankle-brachial index, imaging, and risk-factor management to prevent complications such as heart attack, stroke, or limb loss.
Sources
- American Heart Association. What is Peripheral Artery Disease? Accessed May 2, 2024.
- Merck Manual Professional Version. Peripheral Arterial Disease. Accessed May 2, 2024.
- Centers for Disease Control and Prevention. Peripheral Arterial Disease (PAD). Accessed May 2, 2024.
- National Heart, Lung, and Blood Institute. What Is Peripheral Artery Disease? Accessed May 2, 2024.
- National Library of Medicine. Peripheral Arterial Disease. Accessed May 2, 2024.