What Is Peripheral Artery Disease (PAD)?

Medically Reviewed by Brunilda Nazario, MD on October 19, 2021
6 min read

Peripheral artery disease, sometimes called peripheral arterial disease or PAD, is a condition in which your arteries are narrowed and can’t carry as much blood to the outer parts of your body, like your arms and legs. It’s a form of peripheral vascular disease.

Cramps that start when you’re moving and go away with rest are one of the warning signs of PAD. You will usually feel it in your legs, but it can be in other parts of your body, too. You can get PAD in your arms, head, stomach, and kidneys.

  • You may also hear PAD called:
  • Hardening of the arteries
  • Peripheral arterial disease
  • Peripheral vascular disease
  • Poor circulation

If you don’t get treatment, you could be more likely to have a heart attack or stroke. It can also lead to you needing to have a limb removed (amputation).

The most common cause of PAD is a blockage in the arteries, the vessels that carry blood away from the heart. This condition is called atherosclerosis. It happens when things in your bloodstream like fat and cholesterol form plaques that build up in your arteries.

Plaques are made up mostly of fat and are waxy at first. They collect slowly, so you don’t even know they’re there. Over time, plaque buildup makes your arteries harder and narrower. It’s a lot like old plumbing in a house. When there’s gunk in the pipes, water drains slowly, and the pipes start to clog. With plaque in your arteries, your blood flow slows, and your body doesn’t get the oxygen it needs.

Doctors don’t know exactly why plaque builds up in the first place. They think it’s a slow-growing disease that could have its start in childhood.

What are some less common PAD causes?

If you don’t have atherosclerosis, your doctor may start to look for:

  • Infection or inflammation of a blood vessel
  • Injury to your arms or legs
  • Irregular shape of your muscles or ligaments (the tissue that connects your bones or joints together)
  • Exposure to radiation

If you have heart disease, you have a 1-in-3 chance of having PAD. Other things that raise your chance of having PAD include:

Smoking is the single biggest PAD risk factor that is in your control. It raises your risk for PAD by 400% compared with nonsmokers. And in people who get PAD, smokers tend to get symptoms 10 years earlier than nonsmokers. 

In addition, smokers with PAD do less well after certain types of heart bypass surgery, are twice as likely to require limb amputation, and die more often of stroke or heart attack.  

Talk to your doctor about medications and therapies that can help you quit smoking.

You may have muscle pain or cramping because there’s less blood flow to your legs. This type of pain is called claudication. You usually feel it when you walk or climb stairs, but it stops when you rest.

It can affect different muscle groups, including:

  • Buttock and hip
  • Calf (most common)
  • Foot (less common)
  • Thigh

What about symptoms in advanced PAD?

Some people have a sense of burning or numbness. If you have an advanced form of PAD, your toes or feet might hurt even while you’re resting.

Other signs and symptoms might include:

  • Changes in the color of your legs
  • Erectile dysfunction, most often in men with diabetes
  • Leg weakness
  • Fatigue while walking, especially in legs
  • Legs that are cooler than your arms
  • One leg that feels colder than the other
  • Loss of hair on your legs
  • Fainter pulse in your feet
  • Shiny skin on your legs
  • Skin that looks pale or kind of blue
  • Slow toenail growth
  • Wounds or sores on your toes or feet that don’t heal well

If you have PAD in your arms, you’ll have similar symptoms to the ones in your legs. You may feel pain, cramps, or heaviness during activities, but it goes away when you rest.

You may notice that your hands are cold or numb and that your fingers look blue or pale. And you may also have sores on your arms and hands that don’t seem to heal.

You can also have severe blockages with no pain at all. This usually is because your body grows blood vessels around the blockages.

When should you talk to your doctor?

If you have leg pain when you walk or any other PAD symptoms, talk to your doctor about it. Smoking is the main cause of this condition, but age and diabetes also play a role. Even if you don’t have symptoms, ask your doctor about PAD if you’re 70 or older. You should also ask about it if you’re 50 or older and you have diabetes or have ever been a smoker.

If you have diabetes before age 50, talk to your doctor about PAD if any of the following are also true:

  • You have a family history of PAD, heart attack, or stroke
  • You have high blood pressure
  • You have high cholesterol
  • You smoke now or you have in the past
  • You’re African American
  • You’re very overweight

Your doctor will start with a physical exam to look for signs of PAD. They might check blood flow in your legs and feet and listen for a whooshing sound in your leg arteries.

You might get other tests, including:

  • Angiogram, in which your doctor uses a needle to put dye into your bloodstream before taking an X-ray to find blocked arteries
  • Ankle-brachial index, which compares blood pressure in your lower leg and your upper arm
  • Blood tests to check for risk factors like diabetes or high cholesterol
  • Ultrasound to check blood flow and find blocked arteries

If you have PAD, your doctor can tell you about the best treatment for you. It could mean changes to your lifestyle, new medicine, or for more advanced cases, surgery.

There are some simple things your doctor might recommend to help manage your symptoms and keep your PAD from getting worse. These include:

You also might need medical treatments including:

  • Angioplasty. This procedure uses a catheter, a thin tube, to put a tiny balloon into your artery. When it’s inflated, the balloon pushes plaque out to widen the artery and restore blood flow. Your doctor might also put a mesh tube called a stent into your artery to keep it open.
  • Medications. The drug cilostazol eases symptoms in many people. Pentoxifylline is another medication that can help with poor circulation. Doctors may also prescribe aspirin or other anti-clotting drugs. You also might take medicines to lower your cholesterol, blood pressure, or blood sugar.
  • Surgery. If needed, your doctor can route your blood flow around a blocked artery with a procedure called a bypass graft.

PAD can be a warning sign because if you have plaque in your legs, you probably have it in other places, too.

You may have build-up in the arteries of your heart. This is called coronary artery disease. You may also have it in the ones that go to your kidneys. This is known as renal artery disease. This can also happen in the carotid arteries, which carry blood to the brain, leading to a stroke.

If you have PAD and diabetes, you have a higher chance of getting what’s called critical limb ischemia. This starts with a sore or infection, usually in your foot or leg. But it doesn’t heal or go away. In some cases, you may need to have your foot or part of your leg removed.         

Healthy lifestyle choices are the first step to helping to prevent PAD. The single biggest effect you can have is to stop smoking. Or don’t start. That means:

  • Regular exercise: Shoot for 30 minutes on most days of the week to start. Check with your doctor first if it’s been a while since you exercised.
  • Healthy eating: Try proven approaches like the DASH diet or ask your doctor about the best diet for you.
  • Stress control: Careful planning of your day can help keep stress down. Meditation, yoga, and regular downtime can help you unwind.
  • Manage conditions: Treat or help prevent conditions that raise your PAD risk like high blood pressure, diabetes, and high cholesterol.  

Remember that it’s often hard to detect symptoms of PAD, especially in the initial stages. Regular checkups can help with early diagnosis and treatment that can keep the worst symptoms and complications of PAD at bay.      

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