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Peripheral Arterial Disease (PAD)

Peripheral arterial disease (PAD) is a condition in which the arteries that carry blood to the arms and legs become narrowed or blocked. This can reduce blood flow to the extremities, making them feel numb, weak, or painful. In severe cases, PAD can lead to ulcers, pain at rest, gangrene, and even amputation.

What is Peripheral Arterial Disease?

Peripheral arterial disease (PAD) is a condition that affects the blood vessels that supply blood to the arms and legs. The arteries in the arms and legs can become narrowed or blocked, which reduces blood flow to the extremities. When walking or exercising, PAD sufferers experience muscle pain or cramping in the hips, thighs, or calves. Symptoms are typically relieved by rest. Without treatment, PAD can progress and lead to tissue damage, gangrene, amputation, and severe cardiovascular events.

PAD is a common condition, affecting about 20% of people over 65. It is more common in men than women and more common in people with other risk factors for heart disease, such as smoking, diabetes, high blood pressure, and high cholesterol.

Causes and Symptoms of Peripheral Arterial Disease

The most common cause of peripheral arterial disease (PAD) is atherosclerosis, a process in which fatty deposits accumulate on the inner walls of arteries, forming plaques. Over time, these plaques can narrow and harden the arteries, restricting blood flow.

The symptoms of PAD can vary depending on the severity of the narrowing or blockage. Some people with PAD may have no symptoms at all. Others may experience pain, numbness, or weakness in the arms or legs, especially when they exercise. They may also have cold feet or hands. In severe cases, PAD can lead to ulcers, gangrene, and even amputation. Early detection and management are crucial to prevent complications and improve overall cardiovascular health.

Causes of Peripheral Arterial Disease (PAD)

  • Atherosclerosis
    The most common cause of PAD is atherosclerosis, a gradual accumulation of cholesterol and other fatty materials within the arteries. Atherosclerosis is typically caused by one or more of several other conditions and risk factors, including:
  • Smoking
    Smoking damages the lining of the arteries, making them more likely to develop plaque. 
  • Diabetes
    Diabetes can damage the blood vessels, making them more likely to develop plaque.
  • High blood pressure
    High blood pressure can damage the walls of the arteries, making them more likely to develop plaque.
  • High cholesterol
    High blood pressure can damage the walls of the arteries, making them more likely to develop plaque.
  • High cholesterol
    High cholesterol can contribute to the buildup of plaque in the arteries.
  • Obesity
    Obesity can increase the strain on blood vessels and promote atherosclerosis.
  • Age
    As people age, the risk of developing PAD increases due to the gradual accumulation of plaque.
  • Family history
    Genetics play a role, and individuals with a family history of PAD are more prone to developing the condition.

Symptoms of Peripheral Arterial Disease (PAD)

  • Claudication
    Pain, cramping, or discomfort in the legs during physical activity, such as walking or climbing stairs. This pain often subsides with rest.  Some people may also experience pain in their lower legs at night.
  • Numbness or weakness
    Some people experience numbness or weakness in the legs, particularly at rest or during sleep.
  • Coolness and discoloration
    The affected limb may feel cooler than the rest of the body, and the skin may appear pale or bluish.
  • Slow-healing wounds
    Poor circulation can lead to delayed wound healing, making individuals more susceptible to infections.
  • Gangrene
    Severe PAD can result in tissue death (gangrene), causing the skin to turn black and potentially requiring amputation.
  • Erectile dysfunction
    In men, PAD can lead to reduced blood flow to the genital area, causing difficulties with erections.

Testing & Diagnosis for Peripheral Arterial Disease

Early detection and accurate diagnosis of Peripheral Arterial Disease (PAD) are essential for effective management and prevention of complications. The type of testing used to diagnose PAD will vary depending on the individual's symptoms and medical history. Sometimes, a combination of tests may be used to get a complete picture of the patient's condition. There are several tests that can be used to diagnose and evaluate PAD.

  • Ankle-brachial index (ABI)
    This test is typically the first test ordered to evaluate for PAD and the most important for establishing a diagnosis. The ABI compares the blood pressure in the ankle to the blood pressure in the arm. A healthy ABI is 0.9 or higher. An ABI of less than 0.9 may indicate PAD.  
  • Doppler ultrasound
    This test uses sound waves to create images of the arteries. Doppler ultrasound can measure blood flow in the arteries and identify areas of narrowing or blockage.
  • Computed tomography angiography (CTA)
    This test uses X-rays to create detailed images of the arteries. CTA can be used to identify areas of narrowing or blockage and assess the severity of PAD.
  • Magnetic resonance angiography (MRA)
    This test uses magnets and radio waves to create detailed images of the arteries. MRA is an excellent alternative to CTA for people who cannot have X-rays.
  • Invasive Angiography
    This test involves placing a small catheter into an artery in the body and then injecting dye into the artery while using a large X-ray machine to obtain images of the artery. Angiography is the most invasive test for diagnosing PAD, but it can provide the most detailed images of the arteries.

Treatments for Peripheral Arterial Disease

Peripheral Arterial Disease (PAD) is a serious condition that is often treatable. With early diagnosis and treatment, people with PAD can live long and active lives. Once PAD is diagnosed, the doctor will work with the patient to develop a treatment plan. Treatment options for PAD include exercise, smoking cessation, other lifestyle changes, medications, and surgery.

  • Exercise
    Exercise is the initial treatment of choice for patients with claudication.  Exercise is ideally performed under medical supervision (called “supervised exercise therapy”), but unsupervised exercise programs–in which a patient follows an exercise prescription from a doctor–are also highly effective.  Exercise helps reduce symptoms, improve quality of life, delay disease progression, and improve overall health and wellbeing.
  • Smoking cessation
    Smoking is one of the most significant causes of PAD.  Smoking cessation is a cornerstone of PAD treatment for patients who have PAD and smoke.
  • Treating Diabetes
    Diabetes is another major cause of PAD.  In patients with PAD who also have diabetes, it is critical to the effective treatment of PAD.
  • Other lifestyle changes
    Healthy lifestyle changes are crucial in managing PAD and improving overall cardiovascular health. In addition to recommendations regarding exercise and smoking cessation, your doctor may recommend a healthy diet, weight management, and blood pressure and cholesterol control.
  • Medications
    Various medications may be prescribed to manage symptoms and underlying risk factors. These may include Aspirin, Statins, Cilostazol, and Vasodilators.
  • Skin care
    Patients with PAD are at increased risk for skin breakdown and skin infections and may have trouble with healing when they have cuts.  Your doctor may, therefore, recommend measures to help take care of your skin to reduce the risk of developing cuts, open wounds, and skin infections.
  • Angioplasty
    Angioplasty involves inserting a balloon into a narrowed or blocked artery and then inflating the balloon to widen the artery.
  • Stent placement
    A stent is a small mesh tube that can be inserted into a narrowed or blocked artery to keep it open.
  • Bypass surgery
    Bypass surgery involves creating a new pathway for blood to flow around a narrowed or blocked artery.


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