Peripheral Artery Disease affects over 8.5 million Americans, occurring when narrowed arteries reduce blood flow to the limbs, most commonly the legs. This circulatory problem develops when fatty deposits (atherosclerosis) build up in artery walls, restricting oxygen-rich blood from reaching your extremities.
Peripheral Artery Disease (PAD)
Overview and Symptoms
Overview and Symptoms
PAD develops when cholesterol, calcium, and other substances in your blood build up in peripheral arteries that supply blood to your limbs. This plaque buildup causes arteries to narrow or become blocked, reducing circulation.
Common causes and contributing factors include:
- Atherosclerosis (plaque buildup in arteries)
- Diabetes (leading cause of PAD)
- High blood pressure
- High cholesterol
- Smoking (increases risk 4x)
The most common symptoms of PAD include:
- Claudication - leg pain when walking that subsides with rest
- Leg numbness or weakness
- Colder lower leg or foot compared to other leg
- Poor toenail growth
- Hair loss on legs and feet
Advanced PAD symptoms may include:
- Leg pain even at rest (especially at night)
- Skin color changes (pale, bluish, or reddish)
- Shiny, tight skin on legs
- Non-healing wounds on toes, feet, or legs
- Erectile dysfunction in men
- Gangrene in severe cases
Risk Factors
- Age over 50 (risk increases with age)
- Smoking or tobacco use
- Diabetes mellitus
- High blood pressure
- High cholesterol
- Obesity (BMI over 30)
- Family history of PAD, heart disease or stroke
- Sedentary lifestyle
- High homocysteine levels
- History of coronary artery disease
Diagnosis typically involves ankle-brachial index (ABI) testing, ultrasound, angiography, or other vascular imaging studies to assess blood flow.
Treatment
Early PAD treatment focuses on lifestyle changes and medication, while advanced cases may require surgical intervention to restore blood flow.
Treatment options include:
- Lifestyle modifications: Smoking cessation, supervised exercise program, healthy diet low in saturated fats
- Medications: Antiplatelet drugs (aspirin/clopidogrel), cholesterol-lowering statins, blood pressure medications, cilostazol for claudication
- Minimally invasive procedures:
- Angioplasty (balloon dilation of blocked artery)
- Stent placement to keep artery open
- Atherectomy (plaque removal)
- Surgical options:
- Bypass surgery using a graft vessel
- Endarterectomy (plaque removal from artery)
- Amputation in severe cases with gangrene
- Advanced therapies:
- Drug-coated balloons
- Bioabsorbable stents
- Therapeutic angiogenesis research
Regular follow-up with a vascular specialist is crucial as PAD increases risk for heart attack and stroke by 4-5 times.