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Peripheral Arterial Disease (P.A.D.)



Are you suffering from leg pain, burning or aching in your calves, a wound in your foot or leg that won't heal? You may have Peripheral Arterial Disease.

Peripheral Arterial Disease (P.A.D.) occurs when leg arteries become narrowed or blocked by plaque, a condition that raises the risk of heart attack, stroke, leg amputation and death. This condition affects 8-12 million Americans, as compared to 8.4 million Americans who have a history of cancer. With only about 25 percent of P.A.D. patients undergoing treatment, it is a disease that is largely under-diagnosed and under-treated.

P.A.D. can be characterized by a reduction in blood flow to the lower extremities due to plaque build-up in the leg arteries (also known as atherosclerosis). Plaque is made up of deposits of fats, cholesterol and other substances. Plaque formations can grow large enough to significantly reduce blood flow through an artery.

When leg arteries are hardened and clogged, blood flow to the legs and feet is reduced. The blockage remains in the peripheral arteries and can cause pain, changes in skin color and temperature, sores or ulcers and difficulty walking. If left untreated, P.A.D. can lead to Critical Limb Ischemia (CLI), a condition where not enough blood is being delivered to the leg to keep the tissue alive. Total loss of circulation to the legs and feet can cause gangrene and lead to amputation. Additionally, hardened arteries found in people with P.A.D. are a sign that they are likely to have hardened and narrowed arteries to the heart and the brain. As a result, people with P.A.D. are at high risk for having a heart attack or a stroke. People with P.A.D. may become disabled and not be able to go to work. As time goes on, they may have a very poor quality of life.

What puts you at risk for Peripheral Arterial Disease (P.A.D.)?

The chance of having Peripheral Arterial Disease (P.A.D.) increases as you get older. People over the age of 50 have a higher risk for P.A.D., but the risk is increased with the following:

  • Smoking

    Individuals who smoke or have a history of smoking could potentially have a 4x greater risk of P.A.D.
  • High blood pressure

    People who have high blood pressure also have a higher risk of having P.A.D.
  • High cholesterol

    When there is too much cholesterol in your blood, the walls of your blood vessels can become narrowed or clogged with fatty deposits called plaque.
  • Diabetes

    People with diabetes are at higher risk for having P.A.D.
  • Obesity

  • Physical inactivity

Signs and Symptoms of Peripheral Arterial Disease (P.A.D.)

Peripheral Arterial Disease (P.A.D.) develops slowly over many years. In the early stages, most people with P.A.D. have no symptoms. Only about one out of four people with P.A.D. actually feel symptoms of P.A.D.

Below are typical signs and symptoms of P.A.D.

  • Claudication (pain), fatigue, heaviness, tiredness, cramping in the leg muscles (buttocks, thigh, or calf) that occurs during activity such as walking or climbing stairs.
  • Pain in the legs and/or feet that disturb sleep.
  • Sores or wounds on toes, feet, or legs that heal slowly, poorly, or not at all.
  • Color changes in the skin of the feet, including paleness or blueness.
  • Lower temperature in one leg compared to the other leg.
  • Poor nail growth and decreased hair growth on toes and legs.
  • Leg muscle atrophy (wasting or loss of muscle tissue).

How is Peripheral Arterial Disease (P.A.D.) Diagnosed?

If you think you have Peripheral Arterial Disease (P.A.D.), see your health care provider and talk about any symptoms you are having. Your provider may go over your medical history and conduct examinations to determine if you have P.A.D.

  • Review of medical history

    The first step in determining whether a person has P.A.D. is to take a thorough medical history.
  • Perform medical examination

    Your physician may do a series of tests to assess symptoms of P.A.D.
  • Ankle-brachial index (ABI)

    The ABI is a test that involves taking the blood pressure at several locations in the body and doing a simple calculation.
  • Exercise testing

    The ABI can be supplemented with an exercise test.
  • Pulse volume recording and segmental pressures

    These two additional non-invasive tests may be done to determine where an artery is occluded.
  • Ultrasound duplex scans

    This is another non-invasive method. It can provide clinicians with information about the thickness of artery walls, blood vessel structure, blood flow velocity and blood flow turbulence.
  • MRI scans & CT scans

    Magnetic Resonance Imaging (MRI) and Computed Tomography (CT) scans may be performed prior to surgical interventions in some persons.

Progression of Peripheral Arterial Disease (P.A.D.)

  • Critical Limb Ischemia

    Critical Limb Ischemia (CLI) is chronically impaired blood flow to an affected limb. Multiple factors contribute to CLI, including diabetes and severe low cardiac output. Persons with CLI often have limb pain even when resting.

    Persons with CLI may be at an increased risk of cardiovascular ischemic events. If persons with CLI do not undergo some form of revascularization, they may need amputation within 6 months.
  • Acute Limb Ischemia

    Acute Limb Ischemia (ALI) occurs when the blood flow to an extremity is cut off suddenly. This happens when a clot forms in the blood vessel or when one travels there from another location. ALI requires immediate evaluation and treatment.
  • Amputation

    If Peripheral Arterial Disease (P.A.D.) has progressed beyond claudication, the person may develop an infection. If a large blockage occurs, the person could develop gangrene, which is death of bodily tissue from lack of blood supply. When a larger portion of the lower leg is affected, or if there is a serious infection or advancing gangrene, the foot or part of the leg may need to be removed. With more serious disease progression, a below-the-knee amputation (BKA) or above-the-knee amputation (AKA) may become necessary.