What Is Peripheral Arterial Disease?

Peripheral arterial disease (P.A.D.) occurs when plaque (plak) builds up 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 arteries, the condition is called atherosclerosis (ATH-er-o-skler-O-sis). 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 legs, but also can affect the arteries that carry blood from your heart to your head, arms, kidneys, and stomach. This article focuses 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 that’s 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 and numbness. It also can raise your risk of getting an infection in the affected limbs. It may be hard for your body to fight the infection.

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

If you have leg pain when you walk or climb stairs, talk to your doctor. Sometimes older people think that leg pain is just a symptom of aging. However, the cause for 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.

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

Outlook

If you have P.A.D., your risk for coronary artery disease, heart attack, stroke, and transient ischemic attack (“mini-stroke”) is six to seven times greater than the risk for people who don’t have P.A.D. If you have heart disease, you have a 1 in 3 chance of having blocked leg arteries.

Although P.A.D. is serious, it’s treatable. If you have the disease, it’s important to 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.

Other Names for Peripheral Arterial Disease

• Atherosclerotic peripheral arterial disease
• Peripheral vascular disease
• Vascular disease
• Hardening of the arteries
• Claudication
• Poor circulation
• Leg cramps from poor circulation

What Causes Peripheral Arterial Disease?

The most common cause of peripheral arterial disease (P.A.D.) is atherosclerosis. The exact cause of atherosclerosis isn’t known.

The disease may start when 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.

Over time, the plaque may crack. Blood cell fragments called platelets stick to the injured lining of the artery and may clump together to form blood clots.

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.

Who Is At Risk for Peripheral Arterial Disease?

Peripheral arterial disease (P.A.D.) affects 8 to 12 million people in the United States. African Americans are more than twice as likely as Caucasians to have P.A.D.

The major risk factors for P.A.D. are smoking, age, and having certain diseases or conditions.

Smoking

Smoking is more closely related to getting P.A.D. than any other risk factor. Your risk for P.A.D. increases four times if you smoke or have a history of smoking. On average, smokers who develop P.A.D. have symptoms 10 years earlier than nonsmokers who develop P.A.D.

Quitting smoking slows the progress of P.A.D. Smoking even one or two cigarettes a day can interfere with P.A.D. treatments. Smokers and people who have diabetes are at highest risk for P.A.D. complications, including gangrene (tissue death) in the leg from decreased blood flow.

Age

As you get older, your risk for P.A.D. increases. Genetic or lifestyle factors cause plaque to build in your arteries as you age.

About 5 percent of U.S. adults who are older than 50 have P.A.D. Among adults aged 65 and older, 12 to 20 percent may have P.A.D. Older age combined with other risk factors, such as smoking or diabetes, also puts you at higher risk.

Diseases and Conditions

A number of diseases and conditions can raise your risk for P.A.D. These include:

• Diabetes. One in three people who has diabetes and is older than 50 is likely to have P.A.D.
• High blood pressure or a family history of it.
• High blood cholesterol or a family history of it.
• Heart disease or a family history of it.
• Stroke or a family history of it.

What Are the Signs and Symptoms of Peripheral Arterial Disease?

At least half of the people who have peripheral arterial disease (P.A.D.) don't have any signs or symptoms of it. Others may have a number of signs and symptoms.

Even if you don’t have signs or symptoms, discuss with 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. These 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 (klaw-de-KA-shen). During physical activity, your muscles need increased blood flow. If your blood vessels are narrowed or blocked, your muscles won’t get enough blood. When resting, the muscles need less blood flow, so the pain goes away.

About 10 percent of people who have P.A.D. have claudication. This symptom is more likely in people who also have atherosclerosis in other arteries.

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

How Is Peripheral Arterial Disease Diagnosed?

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

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

Specialists Involved

Primary care doctors, such as internists and family practitioners, may treat people who have mild P.A.D. For more advanced P.A.D., a vascular specialist may be involved. This is a doctor who specializes in treating blood vessel problems.

A cardiologist also may be involved in treating people who have P.A.D. Cardiologists treat heart problems, such as CAD and heart attack, which often affect people who have P.A.D.

Medical and Family Histories

To learn about your medical and family histories, your doctor may ask:

• Whether you have any risk factors for P.A.D.
• About your symptoms, including any symptoms that occur when walking, exercising, sitting, standing, or climbing
• About your diet
• About any medicines you take, including prescription and over-the-counter medicines
• Whether anyone in your family has a history of cardiovascular disease

Physical Exam

During the physical exam, your doctor will look for signs and symptoms of P.A.D. He or she may check the blood flow in your legs or feet to see whether you have weak or absent pulses.

Your doctor also may check the pulses in your leg arteries for an abnormal whooshing sound called a bruit (broo-E). He or she can hear this sound with a stethoscope. A bruit may be a warning sign of a narrowed or blocked section of artery.

During the physical exam, your doctor may compare blood pressure between your limbs to see whether the pressure is lower in the affected limb.

He or she also may check for poor wound healing or any changes in your hair, skin, or nails that may be signs of P.A.D.

Diagnostic Tests

Ankle-Brachial Index

A simple test called an ankle-brachial index (ABI) is often 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 ABI test. The ABI compares blood pressure in the ankle to blood pressure in the arm. As the cuff deflates, the blood pressure in the arteries is recorded.

Doppler Ultrasound

A Doppler ultrasound is a test that uses sound waves to show whether a blood vessel is blocked. This test uses a blood pressure cuff and special device to measure blood flow in the veins and arteries of the limbs. A Doppler ultrasound can help find out how severe P.A.D. is.

Treadmill Test

A treadmill test can show how severe your symptoms are and what level of exercise brings them on. For this test, you walk on a treadmill. This shows whether you have any problems during normal walking.

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

Magnetic Resonance Angiogram

A magnetic resonance angiogram (MRA) uses magnetic and radio wave energy to take pictures of blood vessels inside your body. An MRA is a type of magnetic resonance imaging (MRI).

An MRA can find the location of a blocked blood vessel and show how severe the blockage is.

If you have a pacemaker, man-made joint, stent, surgical clips, mechanical heart valve, or other metallic devices in your body, you might not be able to have an MRA. Ask your doctor whether an MRA is an option for you.

Arteriogram

An arteriogram provides a "road map" of the arteries. It’s used to find the exact location of a blocked artery.

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

Some hospitals use a newer method of arteriogram that uses tiny ultrasound cameras that take pictures of the insides of the blood vessels. This method is called intravascular ultrasound.

Blood Tests

Your doctor may recommend blood tests to check for P.A.D. risk factors. For example, you may get a blood test to check for diabetes. You may also get a blood test to check your cholesterol levels.

How Is Peripheral Arterial Disease Treated?

Treatments for peripheral arterial disease (P.A.D.) include lifestyle changes, medicines, and surgery or procedures.

The overall goals of treating P.A.D. are to reduce symptoms, improve quality of life, and prevent complications. Treatment is based on your signs and symptoms, risk factors, and results from a physical exam and tests.

Lifestyle Changes

Treatment often includes making long-lasting lifestyle changes, such as:

• Quitting smoking. Your risk for P.A.D. increases four times if you smoke. Smoking also raises your risk for other diseases, such as coronary artery disease (CAD). Talk to your doctor about programs and products that can help you quit smoking.
• Lowering blood pressure. This lifestyle change can help you avoid the risk of stroke, heart attack, heart failure, and kidney disease.
• Lowering high blood cholesterol levels. Lowering cholesterol can delay or even reverse the buildup of plaque in the arteries.
• Lowering blood glucose levels if you have diabetes. A hemoglobin A1C test can show how well you have controlled your blood sugar level over the past 3 months.
• Getting regular physical activity. 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.

Follow a healthy eating plan that’s low in total fat, saturated fat, trans fat, cholesterol, and sodium (salt). Eat more fruits, vegetables, and low-fat dairy products. If you’re overweight or obese, work with your doctor to create a reasonable weight-loss plan.

Medicines

Your doctor may prescribe medicines to:

• Lower high blood cholesterol levels and high blood pressure
• Thin the blood to prevent clots from forming due to low blood flow
• Help ease leg pain that occurs when you walk or climb stairs

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 man-made tube to make a graft.

This graft bypasses (goes around) the blocked part of the artery, which 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

Your doctor may recommend angioplasty (AN-jee-oh-plas-tee) to restore blood flow through a narrowed or blocked artery.

During this procedure, a catheter with a balloon or other device on the end is inserted into a blocked artery. The balloon is then inflated, which pushes the plaque outward against the wall of the artery. 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.

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.

How Can Peripheral Arterial Disease Be Prevented?

Taking action to control your risk factors can help prevent or delay peripheral arterial 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 this disease, be sure to tell your doctor.

If you smoke, quit. Smoking is more closely related to getting P.A.D. than any other risk factor. Your risk for P.A.D. increases four times if you smoke or have a history of smoking. Talk to your doctor about programs and products that can help you quit smoking.

Follow a healthy eating plan that’s low in total fat, saturated fat, trans fat, cholesterol, and sodium (salt). Eat more fruits, vegetables, and low-fat dairy products. If you’re overweight or obese, work with your doctor to create a reasonable weight-loss plan.

Get regular physical activity. Physical activity can improve your fitness level and your health. Talk to your doctor about what types of activity are safe for you.

These lifestyle changes can reduce your risk for P.A.D. and help prevent and control conditions that can lead to P.A.D., such as diabetes, high blood pressure, high blood cholesterol, heart disease, and stroke.

Living With Peripheral Arterial Disease

If you have peripheral arterial disease (P.A.D.), you’re also more likely to have coronary artery disease (CAD), heart attack, stroke, and transient ischemic attack (TIA, or "mini-stroke"). However, you can take steps to treat and control P.A.D. and lower your risk for these other conditions.

Living With Peripheral Arterial Disease Symptoms

If you have P.A.D., you may feel pain in your calf or thigh muscles after walking. Try to 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., but don’t have symptoms, you should still see your doctor regularly. Take all medicines as your doctor prescribes.

Lifestyle changes can help prevent or delay P.A.D. and other related problems, such as CAD, heart attack, stroke, and TIA. Lifestyle changes include quitting smoking, controlling risk factors, getting regular physical activity, and following a healthy eating plan.

Key Points

• Peripheral arterial disease (P.A.D.) occurs when plaque builds up in the arteries that carry blood to the head, organs, and limbs. When plaque builds up in 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 legs, but also can affect the arteries that carry blood from your heart to your head, arms, kidneys, and stomach.
• Blocked blood flow to your legs can cause pain and numbness. It also can raise your risk of getting an infection in the affected limbs. It may be hard for your body to fight the infection. If severe enough, blocked blood flow can cause tissue death (gangrene). In very severe cases, this can lead to leg amputation.
• The most common cause of P.A.D. is atherosclerosis. The exact cause of atherosclerosis isn’t known. The disease may start when certain factors damage the inner layers of the arteries.
• The major risk factors for P.A.D. are smoking, age, and having certain medical conditions. Smoking is more closely related to getting P.A.D. than any other risk factor. Your risk for P.A.D. increases four times if you smoke.
• At least half of the people who have P.A.D. don’t have any signs or symptoms of it. Some people who have P.A.D. may have symptoms when walking or climbing stairs. These may include pain, numbness, aching, or heaviness in the leg muscles. Symptoms also may include cramping in the legs, buttocks, thighs, calves, and feet.
• P.A.D. is diagnosed based on your medial and family histories, a physical exam, and results from various tests. An accurate diagnosis is important, because people who have P.A.D. are at increased risk for coronary artery disease, heart attack, stroke, and transient ischemic attack. If you have P.A.D., your doctor also may want to look for signs of these conditions.
• Treatments for P.A.D. include lifestyle changes, medicines, and surgery or procedures. Treatment is based on your signs and symptoms, risk factors, and results from a physical exam and tests.
• Taking action to control your risk factors can help prevent or delay P.A.D. and its complications.
• You can take steps to treat and control P.A.D. and lower your risk for complications. Talk to your doctor about taking part in a supervised exercise program. This type of program has been shown to reduce P.A.D. symptoms. Take good care of your feet and legs. See your doctor for checkups as he or she advises, and take all medicines as your doctor prescribes.