What is peripheral artery disease (PAD)?

Peripheral artery disease^[1] (also called PAD or peripheral arterial disease) is a common circulatory problem in which narrowed arteries reduce the flow of blood to your limbs. “Peripheral,” in this case, means away from the heart, into the outer regions of the body. If you have PAD, your extremities (usually the legs) don’t receive enough blood flow to keep up with demand. This decreased blood flow causes the symptoms of PAD—most notably, leg pain when walking (claudication^[2]). Peripheral artery disease, like coronary artery disease^[3], is caused by the widespread accumulation of fatty deposits (plaque) in the arteries (called atherosclerosis^[4]). PAD may reduce blood flow to the brain and heart as well as the legs. Peripheral artery disease can often be treated with healthy lifestyle choices such as exercising, eating a healthy diet, and not smoking.

What is occlusive peripheral arterial disease?

Occlusive peripheral arterial disease^[5] is a blockage or narrowing of an artery in the legs (or, rarely, in the arms) usually caused by atherosclerosis and resulting in decreased blood flow. The condition is common among older people, as atherosclerosis (the buildup of plaque or disease in the walls of blood vessels) becomes more common with aging. Occlusive peripheral arterial disease most commonly develops in the arteries of the legs (including the two branches of the aorta, called iliac arteries, and the main arteries of the thighs, or femoral arteries), knees (popliteal arteries), and calves (tibial and peroneal arteries). Much less commonly, the disease develops in the arteries of the shoulders or arms.

Peripheral artery disease causes

Peripheral artery disease is often caused by^[6] atherosclerosis, a condition in which fatty deposits called plaque build up on the artery walls. This causes the arteries to narrow, decreasing blood flow to the rest of the body. While atherosclerosis is widely known to affect the heart, the disease can—and does—affect arteries throughout the body. When atherosclerosis occurs in the arteries that supply blood to the limbs, it causes peripheral artery disease. Less commonly, peripheral artery disease can be caused by blood vessel inflammation^[7] (vasculitis), injury to the limbs, anatomical abnormalities in the ligaments or muscles, or radiation exposure^[8].

Peripheral artery disease risk factors

Some lifestyle choices and pre-existing conditions may increase your risk of developing peripheral artery disease. One of these factors may lead to PAD, while a combination of one or more may further increase your risk of developing the disease. Some risk factors^[9] for peripheral artery disease include:

• Smoking
• Diabetes^[10]
• Obesity^[11] (a body mass index^[12], or BMI, over 30)
• Hypertension^[13] (high blood pressure)
• High cholesterol^[14]
• Age (especially after reaching 50 years of age)
• A family history of peripheral artery disease, heart disease^[15], or stroke^[16]
• High levels of homocysteine^[17], a protein component that helps build and maintain tissue

People who smoke and/or have diabetes have the greatest risk of developing peripheral artery disease due to reduced blood flow.

Peripheral artery disease symptoms

Many people with peripheral artery disease have mild or no symptoms. Others, however, have leg pain when walking (claudication). Claudication symptoms include muscle pain or cramping in the legs or arms triggered by physical activity that disappears after a few minutes of rest. While the location of this pain depends on the location of the clogged or narrowed artery, pain in the calf is most common. Other common symptoms^[18] of peripheral artery disease include:

• Leg numbness or weakness
• Coldness in the lower leg or foot, especially when compared with the other side
• Sores on the toes, feet, or legs that won’t heal
• A change in the color of the legs
• Hair loss or slower hair growth on the feet and legs
• Slower growth of the toenails
• Shiny skin on the legs
• No pulse or a weak pulse in the legs or feet
• Erectile dysfunction^[19] in men

If peripheral artery disease progresses, pain may occur when at rest or lying down (ischemic leg pain). This pain can be intense and may even be severe enough to disrupt sleep. If you suspect that you have peripheral artery disease or if you develop new or worsened symptoms, see your healthcare provider. He or she will be able to determine the proper diagnosis and treatment for you.

Peripheral artery disease complications

Peripheral artery disease can lead to several complications. If your PAD is caused by atherosclerosis, you are also at risk of developing:

• Critical limb ischemia^[20]: This condition begins as an injury, an infection of the feet or legs, or open sores that don’t heal. Critical limb ischemia occurs when such injuries or infections progress, causing tissue death (gangrene) and, in some cases, requiring amputation of the affected limb(s).
• Stroke and heart attack: Atherosclerosis, which causes the signs and symptoms of peripheral artery disease, isn’t limited to the legs. Plaque deposits can also build up in the arteries that s blood to the heart and brain, which may lead to a stroke or heart attack.