Peripheral Artery Disease

What is peripheral artery disease?

Peripheral artery disease, or PAD, is the same disease process as coronary artery disease — plaque narrowing the arteries — but occurring in the vessels that carry blood to the legs rather than the heart. As those arteries narrow, the leg muscles cannot get enough blood during activity.

PAD is common and frequently missed. Its main symptom is often dismissed as a normal part of aging or attributed to arthritis or back problems.

What are the symptoms?

The hallmark symptom is claudication: cramping, aching, or fatigue in the calf, thigh, or buttock that appears reliably after walking a certain distance and goes away within a few minutes of resting. It then returns at about the same distance the next time.

Other signs include coldness or numbness in the lower leg or foot, a change in skin color, hair loss on the legs, toenail changes, slow-healing sores on the feet or toes, and in advanced cases, pain in the foot at rest — particularly at night.

Some people have no leg symptoms at all, which does not mean the condition is harmless.

Why does PAD matter beyond the legs?

This is the part patients are most often surprised by. PAD is a marker of atherosclerosis throughout the body. Someone with PAD has a considerably higher likelihood of also having significant coronary artery disease and of having a heart attack or stroke. Finding PAD is therefore an opportunity to reduce risk well beyond the legs, through aggressive treatment of cholesterol, blood pressure, diabetes, and tobacco use.

How is PAD diagnosed?

Evaluation begins with checking pulses in the legs and feet and asking carefully about walking symptoms. The standard first test is the ankle-brachial index (ABI), a simple, painless comparison of blood pressure at the ankle against blood pressure at the arm. Vascular ultrasound can show where narrowing is and how severe it is. When a procedure is being considered, angiography provides a detailed map of the arteries.

How is it treated?

Treatment starts with measures that both relieve symptoms and reduce cardiovascular risk:

• Structured walking exercise — one of the most effective treatments for claudication, and often underused
• Stopping tobacco — the single most important step for someone with PAD
• Medications — to control cholesterol and blood pressure, prevent clotting, and in some cases improve walking distance
• Careful foot care — particularly important for people who also have diabetes

When symptoms remain limiting despite these measures, or when circulation is severely reduced, a catheter-based procedure can open the narrowed artery from the inside using a balloon and often a stent. Dr. Afaq Motiwala is board certified in interventional cardiology and endovascular medicine and performs these peripheral procedures.

This page is general health information, not medical advice. It cannot replace an evaluation by a physician who knows your history. Talk with your cardiologist or primary care physician about what applies to you.