What is Peripheral Artery Disease (PAD)?

Peripheral Artery Disease (PAD) is a chronic disorder associated with reduced blood flow to the extremities. PAD often causes severe pain in the extremities, limits mobility, and in some cases may lead to death. In the US alone, PAD affects nearly 12 million people, and if left untreated will lead to Critical Limb Ischemia with an annual cost of care estimated at $10 billion. 1 in every 20 adults over the age of 50 years, and 1 in every 4 adults over the age of 70 years are likely to develop PAD.

The primary cause of the disease is the buildup of fatty acids in the blood vessels, eventually blocking or weakening the vessel walls, ultimately resulting in reduced blood flow to the extremities. Blood clots, diabetes, inflammation, infection and injury can also lead to PAD.

 

PAD symptoms

Those with PAD can suffer from a wide range of symptoms and at differing levels of severity. Many with PAD experience mild symptoms while others can experience severe leg pain when walking. This is known as claudication which can include muscle weakness, muscle pain and cramping in the legs or arms. Calf pain when walking is most common, but pain can also persist in the thigh and buttock. Claudication symptoms tend to disappear after a few minutes of rest.

PAD symptoms often appear when walking or during any type of physical activity. Since PAD restricts or blocks blood flow, the necessary oxygen levels required for physical activity to the legs is impaired. Thus, in many cases, PAD causes severe neuropathic pain. As PAD progresses, pain may be experienced while lying down (ischemic rest pain) and can interfere with sleep. It is important to recognize the early signs of PAD and to seek treatment as soon as possible. In advanced stages of PAD, symptoms can become life threatening and require emergency intervention.

  • Painful cramping in one or both of your hips, thighs or calf muscles after certain activities
  • Leg numbness or weakness
  • Coldness in your lower leg or foot, especially when compared with the other side
  • Sores on your toes, feet or legs that won’t heal
  • A change in the color of your legs
  • Hair loss or slower hair growth on your feet and legs
  • Slower growth of your toenails
  • Shiny skin on your legs
  • No pulse or a weak pulse in your legs or feet
  • Erectile dysfunction in men

  • Smoking
  • Diabetes
  • Obesity (a body mass index over 30)
  • High blood pressure
  • High cholesterol
  • Increasing age, especially after reaching 50 years of age
  • A family history of peripheral artery disease, heart disease or stroke
  • High levels of homocysteine, a protein component that helps build and maintain tissue

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PAD causes and risk factors

Peripheral Artery Disease is often caused by fatty deposits (plaques) that build up on your artery walls and reduce blood flow. This is known as Atherosclerosis and can affect arteries throughout the body and not just the heart as most commonly believed. Another cause of PAD is inflammation of the blood vessels and limb injuries and less prevalent are causes such as ligament or muscle abnormalities and radiation exposure. In most cases, the constriction of the main artery that supplies blood to the legs and lower extremities is the cause of PAD. This obstructs of the internal lining of blood vessels to the limb, skin and muscles.

PAD is usually diagnosed by your physician with a simple test called an ABI (ankle–brachial index) test. ABI compares blood pressure in your arm with blood pressure in your ankle to assess blood flows in your limbs. If the ABI test results show PAD may be affecting your limbs, normally other tests are required to determine which arteries are narrowed or blocked. These tests include:

  • Doppler ultrasound
  • Magnetic resonance angiogram (MRA)
  • Computed tomography (CT) angiogram
  • Catheter-based angiogram (or arteriogram)
  • Treadmill test to determine symptom severity during physical activity
  • Blood test to determine other risk factors (diabetes and cholesterol levels)

PAD is progressive and there are not current cures or direct treatments. Most treatments help to control symptoms, treat pain and slow progression. Treatment for PAD varies dependent upon severity and individual health factors. This includes:

  • Surgical and nonsurgical procedures to restore blood flow but are not permanent solutions
  • Prescription and nonprescription antiplatelet blood thinners
  • Dual antiplatelet therapy (DAPT) to help prevent cardiovascular events
  • Prescription anticoagulant blood thinners
  • Blood pressure, cholesterol or blood sugar medications
  • Lifestyle changes such as smoking cessation, dietary changes and exercise