What Is Peripheral Artery Disease?

Peripheral artery disease (PAD), also known as peripheral vascular disease (PVD) is a common condition where narrowed arteries reduce blood flow to your extremities, and most commonly the legs. Your arteries are also part of your circulatory system (sometimes called your cardiovascular system) and are responsible for carrying fresh, oxygen-rich blood to your organs.

In the U.S., PAD affects more than 6.5 million people over 40 years old. Having PAD raises your risk for heart attack, stroke, and other severe health conditions.

PAD can lead to symptoms like leg pain, numbness, or weakness. In severe cases, it may even cause critical limb ischemia, which can lead to tissue damage.

Treatment typically involves lifestyle management techniques such as avoiding smoking, exercising regularly, and managing contributing conditions like diabetes. Medications and procedures like angioplasty or bypass surgery may also be used to improve your blood flow and alleviate symptoms.

Types

The types of peripheral artery disease are divided in two ways: what areas of the body it affects and how it presents.

The types based on area affected include lower-extremity PAD and upper-extremity PAD. Lower extremity is more common and affects the legs and feet. Upper extremity PAD affects the arms, hands, and fingers.

The types based on presentation include:

• Asymptomatic: No symptoms
• Claudication: Symptoms include fatigue, discomfort, or pain that occurs during activity and is reduced during rest
• Critical limb ischemia: Symptoms include pain during rest, leg cramps while sleeping, or skin lesions such as ulcers or frank gangrene
• Acute limb ischemia (ALI): Symptoms include reduced blood flow to limbs that can result in tissue death

PAD Symptoms

PAD is often underdiagnosed, and symptoms vary widely. Around one in five people with PAD do not have symptoms, while more than half can have atypical signs. Some people with PAD who report not experiencing symptoms do so because they contribute their symptoms to other causes, such as inactivity or aging. Your risk of PAD increases with age.

Some people will only be diagnosed with PAD when their symptoms are severe enough to cause a medical emergency. A healthcare provider can help identify the following symptoms of PAD.

Pain

A common sign of PAD is muscle pain, known as claudication, which can include aching, cramping, numbness, and fatigue. This pain occurs with walking or other physical activity. It is often located in the legs but can also occur in the butt, hip, thigh, calf, or foot.

In severe cases of PAD, muscle pain may not go away even when resting. If your pain is in your feet, lowering your foot below the level of your heart or dangling it off the bed may help reduce the pain. When the legs are downward, gravity helps to pull more blood toward the feet, which can temporarily lessen the pain.

Foot Symptoms

Foot symptoms are common with PAD, especially since the feet and legs are the most affected areas. Foot symptoms may include:

• Cold feet: You may find that your feet are cool or cold to the touch. Blood flow helps keep your legs and feet warm. When your arteries are partly blocked, your body can't get as much blood to areas far from the heart for stable temperature maintenance.
• Numbness: Loss of sensation or a tingling feeling may occur in affected toes or the whole foot.
• Pallor: The skin of the affected area may be especially pale.
• Toenail changes: Toenails may grow more slowly or become thickened, deformed, or discolored. Chronic poor circulation due to narrow or blocked arteries that supply blood to the feet can lead to nail changes over time.

Skin and Hair Changes

People with PAD may develop smooth, shiny skin in affected areas. You may also notice that the color of your skin changes. It may be lighter (hypopigmented) than usual; other times, it may become bluish—a condition known as cyanosis.

PAD can affect your hair as well. You may lose your leg hair, or it may grow much more slowly. Overall, poor blood flow to the skin and hair cells in your legs causes these changes over time.

Tissue Complications

Lack of blood flow from the arteries to the legs and feet may increase your risk of developing sores called arterial ulcers. These ulcers typically happen far from the heart on the legs, feet, ankles, or toes. These wounds can also be slow and difficult to heal, and may turn pale, ashen, or cold.

Decreased amount of muscle, or muscle atrophy, can be a consequence of PAD. Some people with PAD show an overall decrease in calf or other leg muscles. Reduced blood flow to the muscles also decreases the delivery of oxygen and energy. This can reduce your mobility level over time.

If left untreated, PAD can progress to tissue death, or gangrene. Over time, as arteries narrow, you may develop pain even when resting or ulcers that do not heal. This stage of PAD is known as critical limb ischemia (CLI).

Causes

Cholesterol is a waxy substance that travels through your bloodstream and is vital for many bodily functions. People with high cholesterol are at risk of atherosclerosis, which is when cholesterol and other substances form plaque in the arteries.

Your arteries are part of your circulatory system, which is sometimes called your cardiovascular system, and are responsible for carrying fresh, oxygen-rich blood to your organs. However, plaque build-up can reduce or block blood flow to your limbs. This leads to peripheral artery disease.

Diagnosis

If you are experiencing initial symptoms of peripheral artery disease, your healthcare provider may decide to examine your blood flow. This is done using the ankle-brachial index (ABI) test, which compares blood pressure in your legs to the pressure in your arms. A healthy ABI score is between 1.00 and 1.40. However, a score below 0.9 may suggest PAD, though further tests are needed for a diagnosis.

Other tests that can be used to further assess your health and confirm a diagnosis include:

• Blood tests: These can be used to assess your cholesterol, triglyceride, and blood sugar levels, among other measures.
• Exercise ABI test: If your initial ABI test is concerning but not severe, your healthcare provider may want to redo the test while you're exercising to see what level of physical activity you need to perform to experience certain symptoms.
• Six-minute walking test: This test measures how far you can walk over 6 minutes to test your endurance and general function
• Doppler ultrasound: This tool is passed over your skin to find areas of reduced blood flow and assess how quickly your blood is moving through your arteries.
• Segmental Doppler pressure testing: This test uses blood pressure cuffs to assess different areas of your legs for narrowed or blocked arteries.

Treatment for PAD

Your healthcare provider may consult various specialists to help treat PAD, such as a cardiologist, who specializes in heart diseases, or a vascular surgeon, a specialist in blood vessels aside from the heart or brain.

You may be prescribed medications for PAD or similar conditions associated with atherosclerosis, such as:

• Antiplatelet drugs, like aspirin, to prevent blood clots
• Statins, such as Lipitor (atorvastatin) or Crestor (rosuvastatin), to reduce cholesterol
• Vasoactive agents, like Pletal (cilostazol), to increase blood flow

Angioplasty, a procedure to open narrowed blood vessels, may also be recommended. This involves planting a small, metal tube called a stent in the affected arteries to keep them open, allowing blood and oxygen to flow through.

Critical limb ischemia may require bypass surgery to the affected arteries to correct blood flow. Without circulation improvement, tissue death could occur. Unfortunately, there is no cure once the tissue dies. If the wounds become infected or it is impossible to improve blood flow, amputation may be necessary.

Fewer than 5% of people with PAD will have a major limb amputation at or above the ankle after five years. However, about 30% to 50% of people with CLI that hasn't been revascularized (had restored blood flow) within a year may require this type of amputation.

Lifestyle Management

Not smoking, or quitting smoking if you currently smoke, is another very crucial recommendation. The majority of individuals with PAD—up to 80%—previously smoked or are smoking. Smoking increases your risk of heart attacks or worsened PAD. Quitting the use of tobacco may help reduce claudication symptoms.

Exercise can help with claudication symptoms by increasing blood flow to your limbs and supporting muscle mass. It can be helpful to work with a medical professional who helps develop structured exercise programs, such as a physical therapist.

Prevention

For preventing high cholesterol, PAD, or worsening PAD, your healthcare provider may recommend that you:

• Eat foods that are high in fiber or low in saturated fat, salt, and added sugars—namely, whole grains, fruits, vegetables, and lean meat
  
• Maintain a healthy weight
• Regularly exercise
• Not smoking

If a provider diagnoses you with PAD, you will need regular follow-up visits. While there is no cure for PAD, lifestyle changes and treatment can help prevent the worsening of your condition. Heart attack and stroke are major potential complications of PAD, so it is important to take steps to prevent these complications from occurring.

When To Reach Out to a Healthcare Provider

If you have leg pain when walking or other PAD symptoms, immediately contact a healthcare provider for diagnosis. Since some cases of PAD may have no symptoms, keep up with regular annual medical checkups, including blood pressure and cholesterol tests.

Talk to a healthcare provider if you have an increased risk of developing PAD. It is more likely to occur in people with:

• Diabetes
• High blood pressure
• High cholesterol
• A history of smoking
• Older age

Because blockages can occur in any blood vessel, PAD increases the risk of heart disease or stroke.

A Quick Review

High cholesterol is one of several factors that can lead to plaque buildup in the blood vessels. Narrowed or blocked arteries in your legs can cause reduced blood flow, poor circulation, and symptoms of peripheral artery disease. This condition can cause pain with walking, decreased pulses, skin changes, or coldness in the legs and feet.

Be sure to check with a healthcare provider for early diagnosis, symptom management, and treatment to prevent serious complications.