Peripheral Artery Disease

Symptoms of PAD can vary, but there are a few common ones:

• Pain, aching, heaviness or cramping in your legs that comes when walking or climbing stairs and goes away after rest is called intermittent claudication. It is the most common PAD symptom. The pain is often in the calf, but you may also feel it in your buttocks, thigh or foot.
• You may have pain or a feeling of pins and needles in your leg or foot.
• Your toenails and leg hair may stop growing.
• One foot may feel colder than the other.
• Your foot or leg may become pale, discolored, or blue.
• Leg weakness or numbness may make you feel off-balance or make it harder to walk.
• Other symptoms of advanced PAD include pain in your leg and foot when at rest, sores or wounds on your toes, feet or legs appear, heal slowly or not heal at all placing them at high risk of becoming infected.  
• Very advanced PAD, leading to such problems, is called critical limb ischemia, which refers to the risk of the limb not surviving due to lack of adequate blood supply.   

Atherosclerosis is the main cause of PAD. Atherosclerosis is a disease in which a waxy substance called plaque builds up on the inner lining of arteries. Plaque is made up of fat, cholesterol, fibrous tissue and calcium. In PAD, plaque may reduce or fully block the flow of oxygen-rich blood through arteries to the body’s vital organs and the limbs. A person may have atherosclerosis in just a single artery or in many. 

You may have a higher risk of lower extremity PAD because of your age, family history and genetics, lifestyle habits, other medical conditions, race, ethnicity and sex. The risk factors for PAD are mostly the same as those for coronary heart disease and carotid artery disease, which are also caused by atherosclerosis. 

Age, sex and family history

• Age: You can develop PAD at any age, but your risk goes up as you get older. Most people in the United States who have PAD are age 65 or older.
• Genetics: A family history of PAD, heart disease, stroke, or blood vessel disease, such as some types of vasculitis, raises your risk of PAD. Researchers are studying gene variations that seem to increase the risk of PAD or other types of atherosclerotic diseases, such as carotid artery and coronary heart disease.
• Gender: Men and women have a similar risk of developing PAD, but PAD affects men and women differently. For women, complications of pregnancy such as preeclampsia, a high blood pressure disorder, or gestational diabetes, high blood sugar during pregnancy, can raise a woman’s risk of developing PAD later in life. Women are more likely than men to have PAD without symptoms. If symptoms do occur, they may be worse for women than for men. Women who have PAD often cannot walk as far or as fast as men who have PAD. They also report lower quality of life than men do. Depression is also more common in women with PAD than it is in men with the same disease.  
• Race or ethnicity: African American people have a higher risk of PAD than people of other races or ethnicities. African Americans are also more likely to have complications of PAD, such as problems walking or loss of a limb. Additionally, American Indian women have a higher risk of PAD than white or Asian American women. Hispanic or Latino people and white people have similar risk levels. However, research found that rates of lower extremity PAD are higher among Hispanic and Latino adults who have highly sedentary lifestyles, even when they do not have any other risk factors.

Lifestyle choices

Over time, unhealthy lifestyle habits can lead to plaque buildup in the leg and foot arteries, causing PAD. These habits may include the following:

Smoking or regularly breathing in secondhand smoke damages your blood vessels, raises your blood pressure, and impacts cholesterol levels. The nicotine in tobacco also makes your blood vessels tighten and reduces blood flow in your legs. Quitting smoking is the most important step in lowering your risk of PAD.

We understand how challenging it can be to break free from the grip of tobacco and nicotine addiction. That’s why we offer free support and resources to help you quit smoking and using other tobacco products. Learn more about our free tobacco cessation program, including our free nicotine replacement therapy.

Not getting enough physical activity can make other PAD risk factors worse.

Stress can make your arteries tighten and narrow.

Eating foods high in saturated fats and following other unhealthy eating patterns can also increase your risk of PAD. Butter, palm and coconut oils, cheese, and red meat have high amounts of saturated fat. 

Medical conditions

Medical conditions that raise your risk of developing PAD include:

• Diabetes
• High blood pressure
• Obesity
• Unhealthy blood cholesterol levels or high blood triglycerides
• Chronic kidney disease
• Fibromuscular dysplasia, a condition that occurs when cells in the artery walls grow too much, making the artery narrow
• Disorders that cause blood clots, such as thrombocytosis or antiphospholipid syndrome 

PAD is diagnosed through a combination of medical history, physical exams and diagnostic tests. Common tests include: 

• Ankle-brachial index (ABI), which compares blood pressure in the ankle with the arm
• Doppler ultrasound to assess blood flow
• Various imaging techniques like CT or MRI angiography
• Blood tests to check cholesterol, triglyceride and blood sugar levels.

Preventing PAD involves managing risk factors through lifestyle changes and medication. Regular follow-up with healthcare providers is essential to monitor and manage the condition, especially for those with coexisting conditions like diabetes or high blood pressure. Taking care of foot health is crucial for PAD patients to prevent complications like infections or amputations.