Peripheral artery disease, or PAD, affects 8 million Americans—and many don’t know they have it. But PAD is a very serious condition that has also been linked to heart attack and stroke if it’s not treated.
If you have PAD, blood flow to the arms, legs, kidneys and other vital organs can be limited. Without enough oxygen-rich blood, nerves and tissues in these areas can be injured. That’s why, if you have PAD in your legs, it can make walking very difficult; you might have painful cramping or numbness. The lack of blood in the legs can also make infections more likely. In extreme cases when lack of blood flow has been prolonged, muscles and tissue can die and cause some people to need to have their leg amputated, or surgically removed.
The good news is there are a number of treatments and lifestyle changes that can help manage PAD. By treating it, you can also prevent related heart attack, stroke, leg amputations and death. The more informed and equipped you are to manage PAD, the better you’ll feel. Use this condition center to learn more about PAD. You can keep up with the latest research, find questions to ask your doctor, and get tips to help you feel your best.
What is peripheral arterial disease of the legs?
Peripheral arterial disease (PAD) is narrowing or blockage of arteries that causes poor blood flow to your arms and legs. When you walk or exercise, your leg muscles don't get enough blood and you can get painful cramps.
Peripheral arterial disease is also called peripheral vascular disease. This topic focuses on peripheral arterial disease of the legs, the area where it is most common.
What causes PAD?
The most common cause is the buildup of plaque on the inside of arteries. Plaque is made of extra cholesterol, calcium, and other material in your blood. Over time, plaque builds up along the inner walls of the arteries, including those that supply blood to your legs. High cholesterol, high blood pressure, and smoking all contribute to plaque buildup.
If plaque builds up in your arteries, there is less room for blood to flow. Every part of your body needs blood that is rich in oxygen. But plaque buildup prevents that blood from flowing freely and starves the muscles and other tissues in the lower body.
What are the symptoms?
Many people who have PAD don't have any symptoms.
But if you do have symptoms, you may have a tight, aching, or squeezing pain in the calf, thigh, or buttock. This pain, called intermittent claudication, usually happens after you have walked a certain distance. For example, your pain may always start after you have walked a block or two or after a few minutes. The pain goes away if you stop walking. As PAD gets worse, you may have pain in your foot or toe when you aren't walking.
How is PAD diagnosed?
Your doctor will talk with you about your symptoms and past health and will do a physical exam. During the exam, your doctor will check your pulse at your groin, behind your knee, on the inner ankle, and on the top of your foot. Your pulse shows the strength of blood flow. An absent or weak pulse in these spots is a sign of PAD. Your doctor may also look at the color of your foot when it is higher than the level of your heart and after exercise. The color of your foot can be a clue to whether enough blood is getting through your arteries.
You will likely have a test that compares the blood pressure in your legs with the blood pressure in your arms. This test is called an ankle-brachial index. A test called an arterial Doppler ultrasound may be done to check the blood flow in your arteries.
Blood tests to check your cholesterol and blood sugar can tell whether you may have other problems related to PAD, such as high cholesterol and diabetes.
How is it treated?
Treatment for PAD relies mainly on healthy lifestyle changes and taking care to manage high blood pressure and cholesterol. You may need medicines to ease symptoms or to manage other health problems. In some cases, you may need surgery or a procedure called angioplasty.
When you have PAD, you have a high risk of having a heart attack or stroke. Making healthy changes can help reduce this risk.
Lifestyle changes
If you smoke, quit. It's one of the most important things you can do. If you need help, talk to your doctor about programs and medicines that can help you stop.
Eat healthy foods.
Follow an exercise program.
Manage your cholesterol and blood pressure if they are high. You may need medicines to help you do this.
If you have diabetes, keep your blood sugar in a target range.
Lose weight if you need to, and maintain a healthy weight.
Medicines and surgery
If lifestyle changes don't help, your doctor may prescribe a medicine that may relieve the pain when you walk.
For severe PAD, you may need a procedure called angioplasty or bypass surgery to open narrowed arteries or to reroute blood flow around them.
In rare cases, advanced PAD can cause tissues in the leg or foot to die because they don't get enough oxygen as a result of poor blood flow. If this happens, part of the leg or foot must be removed (amputated). This is more common in people who also have diabetes.
Reference: American Academy of Cardiology. https://www.cardiosmart.org/Healthwise/aa10/5361/aa105361