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Peripheral Artery Disease
(Peripheral Vascular Disease)

» Request a referral to a John C. Lincoln peripheral artery disease specialist.

Peripheral artery disease (PAD), is a progressive disorder that narrows blood vessels beyond the heart and brain — on the periphery, or extremities, of the body — primarily in the pelvis, legs and arms. Persons with PAD commonly experience walking-related leg cramping that subsides with rest. If not treated, severe PAD can result in non-healing ulcers and gangrene.

Peripheral artery disease is a type of vascular disease that affects the arteries beyond the heart. However, the terms peripheral artery disease and peripheral vascular disease are often used interchangeably.

Peripheral Artery Disease Causes

The primary cause of PAD is atherosclerosis, a slowly developing condition in which fatty deposits cling to an artery wall. To heal the damage, an artery wall releases chemicals that encapsulate and stabilize the plaque. However, these chemicals are sticky, attracting inflammatory cells, calcium and proteins. These deposits, called plaque, narrow and harden arteries.

Plaque deposits are hard on the outside and mushy on the inside. If a deposit's tough exterior cracks, the body will try to seal the rupture by releasing blood-clotting platelets, which further narrows an artery.

When an artery becomes blocked completely, surrounding soft tissue can be damaged by a lack of oxygen- and nutrient-rich blood flow. This loss of circulation, called ischemia, explains why patients with PAD can develop gangrene and risk amputation of their toes.

Less common causes of PAD include trauma to the arms or legs, infection and muscular or ligament irregularities. Persons with PAD also may have coronary artery disease.

Peripheral Artery Disease Risk Factors

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Request a referral to a John C. Lincoln peripheral artery disease specialist.

A risk factor is anything that enhances the likelihood of disease, but may not directly cause a disease. Because it is a circulatory disease, the risk factors of PAD are very similar to other diseases of the arteries:

  • A personal health history — or family history — of high blood pressure, heart attack, high cholesterol, stroke or diabetes.
  • Smoking.
  • Obesity: Being more than 25 pounds overweight.
  • Eating fried and fatty foods regularly.
  • Inactivity: Not exercising moderately at least four times per week.
  • Age and gender: Men age 50 and over are more often diagnosed with PAD.

The greatest risk factors for PAD are smoking and diabetes, which reduce blood flow to the arms and legs.

Peripheral Artery Disease Symptoms

Approximately half of all PAD patients do not experience PAD symptoms, which progress over time, as blood vessels narrow. The most common PAD symptom is claudication — an intermittent aching, cramping or weakness in the legs, buttocks or arms experienced during walking or exercise, yet disappears with rest.

Other PVD symptoms are:

  • Limping or abnormal gait.
  • Pain in the toes or feet when resting or lying flat at night.
  • Leg, foot or arm ulcers, or sores, that are slow to heal or become infected.
  • Hair loss on the legs or arms.
  • Reddish-purple discoloration of the skin.
  • Thickened toenails that lose transparency and sheen.

In severe cases, PAD can result in gangrene, when a body part — particularly the toes and feet — completely loses circulation.

Peripheral Artery Disease Diagnosis

Diagnosis of PAD begins with a medical history and physical examination. Diagnostic procedures may include:

Angiogram: An X-ray to detect blockage or narrowing of blood vessels. A thin, flexible tube, called a catheter, is inserted into the groin. A contrast dye is injected into arteries and veins; this dye is visible on the X-ray.

Ankle-brachial index (ABI): A comparison of the blood pressure in the ankle with the blood pressure in the arm.

Doppler ultrasound: High-frequency sound waves captured by a computer measure blood flow and create images of blood vessels, tissues and organs.

Magnetic resonance angiography (MRA): A large magnet, radiofrequencies and a computer produce detailed images of organs and structures within the body.

Peripheral Artery Disease Treatment

PAD treatment aims to control symptoms and to prevent disease progression. A treatment plan considers age, overall health, medical history, disease severity and symptoms.

Treatments include lifestyle modification, medication, angioplasty and vascular surgery.

Lifestyle modifications revolve around smoking cessation, regular exercise and proper nutrition. Weight reduction can be achieved with a fruit- and vegetable-rich diet. Alcohol moderation also is important.

Further, treatment can manage existing conditions that aggravate PAD: diabetes, hypertension, and high cholesterol.

Medications prescribed to treat PAD improve blood flow; these include anticoagulants (which prevent blood clots) and beta blockers (which relax blood vessel walls). Procedures for treating PAD include angioplasty and bypass surgery.

  • In angioplasty, a catheter is guided to the artery where blood flow is blocked. If a balloon angioplasty is performed, the catheter will contain a balloon that is inflated at the point of blockage, stretching the clogged artery open and flattening plaque, to restore blood flow. Balloon angioplasty may be followed by stent placement, in which a wire-mesh tube is inserted, to keep the blood vessel open.
  • Bypass surgery is performed to re-route blood flow so that it travels around a narrowed or blocked area of a blood vessel. In many cases, a blood vessel will be harvested, or grafted, from another part of the body.