Peripheral artery disease - legs

Definition

Peripheral artery disease (PAD) is a condition of the blood vessels that supply the legs and feet. It occurs due to narrowing of the arteries in the legs. This causes decreased blood flow, which can injure nerves and other tissues.

Alternative Names

Peripheral vascular disease; PVD; PAD; Arteriosclerosis obliterans; Blockage of leg arteries; Claudication; Intermittent claudication; Vaso-occlusive disease of the legs; Arterial insufficiency of the legs; Recurrent leg pain and cramping; Calf pain with exercise

Causes

PAD is commonly caused by atherosclerosis. This problem occurs when fatty material (plaque) builds up on the walls of your arteries and makes them narrower. The walls of the arteries also become stiffer and cannot widen (dilate) to allow greater blood flow when needed.

As a result, the muscles of your legs cannot get enough blood and oxygen when they are working harder (such as during exercise or walking). If PAD becomes severe, there may not be enough blood and oxygen, even when the muscles are resting.

PAD is a common disorder. It most often affects men over age 50, but women can have it as well. People are at higher risk if they have a history of:

Symptoms

The main symptoms of PAD are pain, achiness, fatigue, burning, or discomfort in the muscles of your feet, calves, or thighs. These symptoms most often appear during walking or exercise, and go away after several minutes of rest.

When PAD becomes severe, you may have:

Exams and Tests

During an exam, the health care provider may find:

When PAD is more severe, findings may include:

Blood tests may show high cholesterol or diabetes.

Tests for PAD include:

Treatment

Things you can do to control PAD include:

Medicines may be needed to control the disorder, including:

If you are taking medicines for high blood pressure or diabetes, take them as your provider has prescribed.

Surgery may be performed if the condition is severe and is affecting your ability to work or do important activities, you are having pain at rest, or you have sores or ulcers on your leg that do not heal. Options are:

Some people with PAD may need to have the limb removed (amputated).

Outlook (Prognosis)

Most cases of PAD of the legs can be controlled without surgery. Although surgery provides good symptom relief in severe cases, angioplasty and stenting procedures are being used in place of surgery more and more often.

Possible Complications

Complications may include:

When to Contact a Medical Professional

Contact your provider if you have:

Prevention

There is no screening test recommended to identify PAD in patients without symptoms.

Some of the risks for artery disease that you CAN change are:

References

Bonaca MP, Creager MA. Peripheral artery disease. In: Zipes DP, Libby P, Bonow RO, Mann DL, Tomaselli GF, Braunwald E, eds. Braunwald's Heart Disease: A Textbook of Cardiovascular Medicine. 11th ed. Philadelphia, PA: Elsevier; 2019:chap 64.

Ridker PM, Libby P, Buring JE. Risk markers and the primary prevention of cardiovascular disease. In: Zipes DP, Libby P, Bonow RO, Mann DL, Tomaselli GF, Braunwald E, eds. Braunwald's Heart Disease: A Textbook of Cardiovascular Medicine. 11th ed. Philadelphia, PA: Elsevier; 2019:chap 45.

Simons JP, Schanzer A. Lower extremity arterial disease: decision making and medical treatment. In: Sidawy AN, Perler BA, eds. Rutherford's Vascular Surgery and Endovascular Therapy. 10th ed. Philadelphia, PA: Elsevier; 2023:chap 108.

US Preventive Services Task Force, Curry SJ, Krist AH, Owens DK, et al. Screening for peripheral artery disease and cardiovascular disease risk assessment with the ankle-brachial index: US Preventive Services Task Force Recommendation Statement. JAMA. 2018;320(2):177-183. PMID: 29998344 pubmed.ncbi.nlm.nih.gov/29998344/.

White CJ. Atherosclerotic peripheral arterial disease. In: Goldman L, Schafer AI, eds. Goldman-Cecil Medicine. 26th ed. Philadelphia, PA: Elsevier; 2020:chap 71.


Review Date: 5/10/2022
Reviewed By: Deepak Sudheendra, MD, MHCI, RPVI, FSIR, Founder and CEO, 360 Vascular Institute, with an expertise in Vascular Interventional Radiology & Surgical Critical Care, Columbus, OH. Review provided by VeriMed Healthcare Network. Also reviewed by David C. Dugdale, MD, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.
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