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Peripheral arterial disease (PAD) is narrowing or blockage of arteries that causes poor blood flow to your arms and legs.
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.
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 in the 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.
Many people who have PAD don't have any symptoms.
If you do have symptoms, you may have weak or tired legs, difficulty walking or balancing, or pain. If you have pain, you might feel 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.
If PAD gets worse, you may have other symptoms caused by poor blood flow to your legs and feet. These include leg pain when you rest.
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.
Treatment for PAD includes ways to relieve symptoms and lower your risk of heart attack and stroke. Healthy lifestyle changes and medicines can help relieve symptoms and lower this risk. 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 along with taking medicines can help reduce this risk.
Your doctor may suggest that you attend a cardiac rehabilitation (rehab) program. In cardiac rehab, you will get education and support to help you make new, healthy habits.
Medicines and surgery
You may take medicine to lower your risk of heart attack and stroke. These medicines help prevent blood clots, manage blood pressure, and manage cholesterol.
If lifestyle changes don't help relieve symptoms, your doctor may prescribe a medicine that may relieve the pain when you walk.
If you have symptoms that make it hard for you to walk, you might choose to have a procedure called angioplasty or bypass surgery. These treatments open narrowed arteries or reroute blood flow around them. Angioplasty or surgery might also be done if blood flow to your leg is severely limited.
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.
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The most common cause of peripheral arterial disease is the buildup of plaque inside blood vessels called arteries. Plaque is made up of excess cholesterol, calcium, and other substances in your bloodstream. Over time, plaque builds up in the walls of the arteries, including the arteries that feed your legs. The plaque deposits decrease the space through which oxygen- and nutrient-rich blood can flow. Poor blood flow "starves" the muscles and other tissues in the lower body.
This process of plaque buildup-called atherosclerosis or "hardening of the arteries"-usually happens throughout the body, including the leg arteries, coronary arteries, and carotid arteries.
Atherosclerosis gradually develops over a lifetime. High cholesterol, high blood pressure, and smoking contribute to atherosclerosis and peripheral arterial disease.
In very rare cases, peripheral arterial disease can be unrelated to atherosclerosis and caused instead by inflammation of the blood vessels (vasculitis) and old injuries that damaged blood vessels.
Many people who have peripheral arterial disease (PAD) don't have symptoms.
If you do have symptoms, you may have a tight, aching, or squeezing pain in your 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.
Only about 1 out of 5 people with PAD have intermittent claudication.footnote 1
Other symptoms of peripheral arterial disease of the legs may include:
If PAD gets worse, you may have other symptoms that are caused by poor blood flow to your legs and feet. These symptoms are not common. They include:
Many things can increase your risk for atherosclerosis and peripheral arterial disease (PAD). These include:
The risk for PAD also increases with age.
People who have the disease in one part of the body are likely to have it in other places, including the legs.
Call your doctor now or seek immediate medical care if:
Health professionals who may be involved in the diagnosis and treatment of peripheral arterial disease (PAD) include:
If your doctor thinks that you may have peripheral arterial disease (PAD), he or she will examine you for physical signs of the disease and will ask about your personal and family medical history. This is a good time to talk with your doctor about any symptoms you have noticed.
Tests you may have to confirm PAD include:
Your doctor may also do other tests to find out if you have health problems that can cause PAD or make it worse. When you have PAD, you are at high risk for coronary artery disease, heart attack, and stroke. Your doctor will check your risk. You may have tests for:
Your treatment for peripheral arterial disease (PAD) will focus on healthy lifestyle changes first. You may need to take medicines to ease leg pain or to help you manage other health problems.
Some people have angioplasty or bypass surgery to improve blood flow to their legs.
It's important to do what you can to improve your health and possibly reverse the buildup of plaque in your arteries. When you have PAD, you have a high risk of having a heart attack or stroke. Making healthy changes and following your treatment plan can reduce this risk.
A cardiac rehab program can help you make lifestyle changes. In cardiac rehab, a team of health professionals provides education and support to help you make new, healthy habits.
See Living With PAD for more ideas about changes you can make and about support to help you make them.
You may need medicines to help lower your risk of heart attack and stroke. These include medicine to prevent blood clots, improve cholesterol, or lower blood pressure. You might take a medicine that can help ease pain while you are walking.
Sometimes peripheral arterial disease gets worse despite treatment. People who have severe PAD may have bypass surgery or other procedures (such as angioplasty) to restore proper blood flow to the legs.
You can prevent or delay peripheral arterial disease (PAD) by taking steps toward a heart-healthy lifestyle. A heart-healthy lifestyle can also help you manage risk factors such as high cholesterol and high blood pressure.
There are many things you can do to keep peripheral arterial disease (PAD) from getting worse. These steps may also help lower your blood pressure and cholesterol, which can help control PAD.
And doing any one of these things can help you reduce your risk of heart attack and stroke, which is important to do when you have PAD.
Take good care of your feet and legs. When you have reduced blood flow to your legs, even minor injuries can lead to serious infections.
Medicines are used to treat symptoms of peripheral arterial disease (PAD) or to help manage other health problems that can raise your risk of heart attack and stroke.
Medicines that help lower your risk of heart attack and stroke:
Medicine to relieve symptoms:
Most of the time, surgery is only done in cases of severe peripheral arterial disease (PAD), such as disabling intermittent claudication; open sores (ulcers that won't heal); or serious skin, bone, and tissue problems (gangrene).
Bypass surgery redirects blood through a grafted blood vessel to bypass the blood vessel that is damaged. The grafted blood vessel may be a healthy natural vein or artery, or it may be man-made.
The methods of bypass surgery vary depending on the size of the affected artery and where it is located.
The type of surgery used to treat PAD will depend on the location of the affected leg artery or arteries.
Endarterectomy is a less common surgery. It is typically done on the large femoral artery, which is in your groin and upper thigh area.
This surgery is done to remove fatty buildup (plaque) and to increase blood flow to the leg. This surgery is done by cutting open the femoral artery and removing the plaque. This surgery may be done by itself, or it may be done at the same time as bypass surgery or angioplasty.
In rare cases, peripheral arterial disease gets so bad that some people need to have a leg, a foot, or part of the foot amputated. People with diabetes are at increased risk for amputation. Amputation is used only when the damage is very severe, possibly life-threatening, and after all other treatment options have been tried.
Also in rare cases, a blood clot in an artery can suddenly and completely block blood flow to a leg or foot. Often, severe pain, numbness, and coldness develop within 1 hour. This blockage is an emergency. Clot-dissolving medicines, surgical removal of the clot, or bypass surgery is needed to restore blood flow.
Angioplasty is used for severe disease that causes pain and limping during exercise, pain when at rest, or open sores. Angioplasty can increase blood flow in a narrowed artery.
During this procedure, a small, thin tube called a catheter is inserted through a blood vessel in the groin and guided to the affected artery. When the catheter reaches the narrowed part of the artery, the surgeon inflates a balloon. The balloon presses the plaque against the wall of the artery. This improves blood flow.
A small, expandable tube called a stent may be placed in a blood vessel to help hold it open.
White C (2007). Intermittent claudication. New England Journal of Medicine, 356(12): 1241-1250.
Other Works Consulted
Alonso-Coello P, et al. (2012). Antithrombotic therapy in peripheral artery disease: Antithrombotic therapy and prevention of thrombosis, 9th ed.-American College of Chest Physicians evidence-based clinical practice guidelines. Chest, 141(2, Suppl): e669S-e690S.
Anderson JL, et al. (2012). Management of patients with peripheral artery disease (compilation of 2005 and 2011 ACCF/AHA guideline recommendations): A report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. Circulation, 127(13): 1425-1443.
Creager MA, Libby P (2015). Peripheral arterial diseases. In DL Mann et al., eds., Braunwald's Heart Disease: A Textbook of Cardiovascular Medicine, 10th ed., vol. 2, pp. 1312-1332. Philadelphia: Saunders.
Fowkes F, Leng GC (2008). Bypass surgery for chronic lower limb ischaemia. Cochrane Database of Systematic Reviews (2).
Smith SC, et al. (2011). AHA/ACCF secondary prevention and risk reduction therapy for patients with coronary and other atherosclerotic vascular disease: 2011 update: A guideline from the American Heart Association and American College of Cardiology Foundation. Circulation, 124(22): 2458-2473. Also available online: http://circ.ahajournals.org/content/124/22/2458.full.
U.S. Preventive Services Task Force (2013). Screening for peripheral arterial disease and cardiovascular disease risk assessment with the ankle-brachial index in adults. U.S. Preventive Services Task Force. http://www.uspreventiveservicestaskforce.org/uspstf/uspspard.htm. Accessed March 24, 2014.
Wennberg PW, Rooke TW (2011). Diagnosis and management of diseases of the peripheral arteries and veins. In V Fuster et al., eds., Hurst's The Heart, 13th ed., vol. 2, pp. 2331-2346. New York: McGraw-Hill.
ByHealthwise StaffPrimary Medical ReviewerAdam Husney, MD - Family MedicineE. Gregory Thompson, MD - Internal MedicineMartin J. Gabica, MD - Family MedicineSpecialist Medical ReviewerRakesh K. Pai, MD - Cardiology, Electrophysiology
Current as ofDecember 6, 2017
Current as of:
December 6, 2017
Adam Husney, MD - Family Medicine
& E. Gregory Thompson, MD - Internal Medicine & Martin J. Gabica, MD - Family Medicine & Rakesh K. Pai, MD - Cardiology, Electrophysiology
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