Peripheral artery disease (PAD)

Peripheral artery disease (PAD) is a disease in which plaque builds up in the arteries that carry blood to your head, organs, and limbs. Plaque is made up of fat, cholesterol, calcium, fibrous tissue, and other substances in the blood. When plaque builds up in the body's arteries, the condition is called atherosclerosis. Over time, plaque can harden and narrow the arteries. This limits the flow of oxygen-rich blood to your organs and other parts of your body.

PAD is sometimes called peripheral vascular disease (PVD), but PAD usually refers to the condition affecting the arteries in the legs.

Many people who have PAD don't have any symptoms. If you have symptoms, they may include:

• Pain, numbness, achiness, or heaviness in the leg muscles. This happens when walking or climbing stairs.
• Weak or absent pulses in the legs or feet
• Sores or wounds on the toes, feet or legs that heal slowly, poorly or not at all
• A pale or bluish color to the skin
• A lower temperature in one leg than the other leg
• Poor nail growth on the toes and decreased hair growth on the legs
• Erectile dysfunction, especially among men who have diabetes

Symptoms of severe PAD include:

• Leg pain that does not go away when you stop exercising
• Foot or toe wounds that won't heal or heal very slowly
• Gangrene (dead tissue caused by an infection or lack of blood flow)
• A decrease in the temperature of your lower leg or foot, compared to the other leg or to the rest of your body

The main risk factor for PAD is smoking. Other risk factors include older age and diseases like diabetes, high blood cholesterol, high blood pressure, heart disease and stroke, as well as obesity and inactivity.

You can find out your risk for PAD right now by taking our online PAD health risk assessment.

PAD diagnosis begins with a physical examination. Your healthcare provider will check for weak pulses in the legs. Your physical examination may include the following:

• Ankle-brachial index (ABI)—This is a painless exam that compares the blood pressure in your feet to the blood pressure in your arms to determine how well your blood is flowing. This inexpensive test takes only a few minutes and can be performed by your healthcare professional as part of a routine exam. Normally, the ankle pressure is at least 90 percent of the arm pressure, but with severe narrowing it may be less than 50 percent.

If an ABI reveals an abnormal ratio between the blood pressure of the ankle and arm, you may need more testing. Your doctor may recommend one of other tests in this list.

• Doppler and ultrasound (duplex) imaging—This is a noninvasive method that visualizes the artery with sound waves and measures the blood flow in an artery to indicate the presence of a blockage. 
• Computed tomographic (CT) Angiography—This noninvasive test can show the arteries in your abdomen, pelvis and legs. This test is particularly useful in patients with pacemakers or stents.
• Magnetic resonance angiography (MRA)—This noninvasive test gives information similar to that of a CT without using X-rays. 
• Angiography—During an angiogram, a contrast agent (a safe chemical substance) is injected into the artery and X-rays are taken to show blood flow, arteries in the legs and to pinpoint any blockages that may be present.

Treatment for PAD focuses on ways to reduce your symptoms and prevent the disease from getting worse, including:

• Lifestyle changes such as increasing physical activity (your doctor may recommend a supervised exercise program), a low-cholesterol diet, and quitting smoking
• Medication to lower blood pressure, lower cholesterol or prevent blood clots

Our specialists will work with you to determine the best treatment plan, which could also include:

• Angioplasty—a minimally invasive procedure in which a surgeon threads a balloon-tipped tube through arteries until it reaches the one that is blocked. The surgeon inflates the balloon, which compresses the plaque in the artery and widens the vessel.
• Stenting—also minimally invasive and may be done at the same time as angioplasty. A stent is a small, metal mesh tube that a surgeon inserts through a catheter to prop open an artery.
• Atherectomy—also minimally invasive, a procedure in which a device is inserted through a catheter into your arteries or veins. The device has a laser or cutting tip that cuts through the accumulated plaque and scrapes it from the artery or vein.
• Bypass surgery—creates a new pathway for blood to flow by bypassing a blocked area in your vein or artery.
• Hybrid open/endovascular procedures—combines traditional (open) surgery with advanced imaging technology.