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Peripheral Artery Disease

(PAD; Peripheral Vascular Disease; PVD; Arteriosclerosis Obliterans)

Definition

Peripheral artery disease (PAD) is a change in blood flow to your arms and legs. It is caused by a narrowing of blood vessels that slows blood flow. It can cause problems such as leg pain when walking.

Causes

PAD is most often caused by a narrowing of blood vessels. The narrowing is often caused by a buildup of plaque called atherosclerosis. The build up occurs over long periods of time and is increased with:

This buildup happens in blood vessels all over the body. It may mean there is an increased risk of heart disease or stroke. PAD may be first sign of atherosclerosis.

Blood clots and inflammation can also narrow blood vessels. These may be caused by medical issues or treatment.

Atherosclerosis
Atherosclerosis

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Risk Factors

PAD is more common in men and in people over 50 years of age. Other factors that may increase your chances of PAD:

  • Family history of PAD
  • Diabetes
  • Smoking
  • High blood pressure or family history of high blood pressure
  • Stroke or family history of stroke
  • High cholesterol or family history of high cholesterol
  • Coronary artery disease (CAD)
  • Obesity
  • Increasing age, especially after 50 years of age
  • High levels of homocysteine
  • HIV infection

Symptoms

Symptoms of PAD will depend on the area that is most affected. Common symptoms include:

  • Pain, fatigue, aching, tightness, weakness, cramping or tingling in the leg(s) brought on by exercise that goes away when resting
  • Numbness and pain of the legs or feet at rest
  • Cold hands, legs, or feet
  • Loss of hair on the legs and/or feet
  • Paleness or blueness of the legs
  • Weak or absent pulse in the leg
  • Sores, ulcer, or infection of the feet and legs that heal slowly
  • Erectile dysfunction

Diagnosis

You will be asked about your symptoms and past health. A physical exam will be done.

During the exam, your doctor may do the following:

  • Check the strength of the pulse in the legs
  • Use a stethescope to listen for abnormal sounds in leg arteries or the abdomen
  • Check blood pressure in the leg

If the doctor suspects a change in blood flow, other tests may be done to confirm change or look for causes. Images of blood vessels can be done with:

Your heart activity may need to be tested. This can be done with an ECG.

Treatment

Early treatment can slow or stop the disease. Treatment options include the following:

Lifestyle Changes

Certain lifestyle changes can improve the health of your heart and blood vessels. Steps that may help you slow or even reverse PAD include:

  • Carefully manage related medical conditions such as:
    • High blood pressure
    • High cholesterol
    • Diabetes
  • Increase physical activity —such as a walking program
  • Quit smoking
  • Eat a heart healthy diet —low in saturated and trans fats and high in vegetables an fruits

Medication

Medications that may help improve blood flow include:

  • Blood thinners to reduce blood clots
  • Statins to lower cholesterol
  • Vasodilators to widen arteries

Pain medication may also be needed to help manage discomfort.

Invasive Procedures

If blood flow is very poor, a procedure may be needed to quickly increase blood flow. Options include:

  • Balloon angioplasty —a balloon is passed into the artery to flatten the plaque and improve blood flow
  • Stent implant—a wire mesh tube is placed in the artery to help keep it open
  • Laser treatment
  • Atherectomy —a tube called a catheter is used to remove plaque inside a blood vessel

Surgery

Surgery may be needed to open arteries that are severely blocked. Options include:

  • Endarterectomy —the lining of the artery is removed, along with plaque build up
  • Bypass surgery—a vein from another part of the body or a graft is used to send blood flow around the blockage

Prevention

A heart healthy lifestyle can decrease the risk of PAD. General steps include:

  • Regular physical activity—aim for 30 to 45 minutes most days
  • Eating a healthful diet
  • Reach and keep a healthy weight
  • Follow diabetes care plan if you have diabetes
  • Quitting or not starting smoking
  • Working with your medical team to manage any related conditions
RESOURCES:

American Heart Association
http://www.heart.org

Family Doctor—American Academy of Family Physicians
https://familydoctor.org

CANADIAN RESOURCES:

Canadian Society for Vascular Surgery
https://vascular.ca

Heart and Stroke Foundation of Canada
http://www.heartandstroke.ca

REFERENCES:

Hennon DR, Siano KA. Diagnosis and treatment of peripheral arterial disease. Am Fam Physician. 2013;88(5):306-310.

Mahmud E, Cavendish JJ, Salami A. Current treatment of peripheral arterial disease: role of percutaneous interventional therapies. J Am Coll Cardiol. 2007;50(6):473-490.

Peripheral artery disease. National Heart, Lung, and Blood Institute website. Available at: https://www.nhlbi.nih.gov/health-topics/peripheral-artery-disease. Accessed January 26, 2021.

Peripheral arterial disease (PAD) of lower extremities. EBSCO DynaMed website. Available at:http://www.dynamed.com/topics/dmp~AN~T114200/Peripheral-arterial-disease-PAD-of-lower-extremities. Accessed January 26, 2021.

Prevention and treatment of PAD. American Heart Association website. Available at: http://www.heart.org/HEARTORG/Conditions/VascularHealth/PeripheralArteryDisease/Prevention-and-Treatment-of-PAD_UCM_301308_Article.jsp#.WphMNWrwZQI. Accessed January 26, 2021.

6/29/2018 DynaMed Plus Systematic Literature Surveillance http://www.ebscohost.com/dynamed: Beckman JA, Duncan MS, Alcorn CW, et al. Association of HIV infection and risk of peripheral artery disease. Circulation. 2018 Mar 13 [Epub ahead of print].

Last reviewed November 2020 by EBSCO Medical Review BoardNicole S. Meregian, PA  Last Updated: 1/26/2021