Peripheral Arterial Disease (PAD)

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Peripheral arterial disease (PAD) in the legs or lower extremities is the narrowing or blockage of the vessels that carry blood from the heart to the legs. It is primarily caused by the buildup of fatty plaque in the arteries, which is called atherosclerosis. PAD can happen in any blood vessel, but it is more common in the legs than the arms.

Prevalence of PAD (%) by Age Group (years)
Bar Chart Title: Prevalence of PAD (percentage) by Age Group (years). The chart reflects the percentage of prevalence of PAD in men and women by age group and how it increases with age. Age Groups: 40-49: Men - 1.28 percent; Women - 1.89 percent. 50-59: Men - 2.33 percent; Women - 3.97 percent. 60-69: Men - 6.2 percent; Women - 5.41 percent. 70-79: Men - 11.01 percent; Women - 9.5 percent.: Men - 26.59 percent; Women - 20.79 percent.

What are the risk factors for PAD?

  • Smoking
  • High blood pressure
  • Atherosclerosis
  • Diabetes
  • High cholesterol
  • Age above 60 years

Both men and woman are affected by PAD; however, African Americans have an increased risk of PAD. Hispanics may have similar to slightly higher rates of PAD compared with non-Hispanic white people. Approximately 6.5 million people age 40 and older in the United States have PAD.1

Other health conditions and disorders of arteries can mimic the symptoms of PAD, and not all PAD is due to atherosclerosis.2,3

If you have PAD, you are at risk for developing coronary artery disease and cerebrovascular disease, which could lead to a heart attack or stroke.4

A normal artery is shown on the left with no blockage. The right artery shows how it's been narrowed by plaque (atherosclerosis), causing decreased blood flow, and PAD.

The image on the left shows a normal artery. The right shows an artery narrowed by atherosclerosis, causing PAD.

What are the signs and symptoms of PAD?

The classic symptom of PAD is pain in the legs with physical activity, such as walking, that gets better after rest. However, up to 4 in 10 people with PAD have no leg pain.1 Symptoms of pain, aches, or cramps with walking (claudication) can happen in the buttock, hip, thigh, or calf.2

Physical signs in the leg that may indicate PAD include muscle atrophy (weakness); hair loss; smooth, shiny skin; skin that is cool to the touch, especially if accompanied by pain while walking (that is relieved by stopping walking); decreased or absent pulses in the feet; sores or ulcers in the legs or feet that don’t heal; and cold or numb toes.2,3

How can I prevent PAD?

  • Get plenty of physical activity to help prevent PAD or improve symptoms of PAD.2
  • Do not use tobacco. Smoking increases the risk of PAD and makes PAD symptoms worse.4
  • Control high blood pressure and manage high blood cholesterol and diabetes.

If you have PAD, participating in supervised exercise training programs can improve and prolong your ability to walk longer distances.

How is PAD diagnosed?

If you have symptoms of PAD, your doctor may do an ankle brachial index (ABI), which is a noninvasive test that measures the blood pressure in the ankles and compares it with the blood pressure in the arms at rest and after exercise. Your doctor may also do imaging tests such as ultrasound, magnetic resonance angiography (MRA), and computed tomographic (CT) angiography.1–3

How is PAD treated?

  • Your doctor may recommend that you take aspirin or other similar antiplatelet medicines to prevent serious complications from PAD and associated atherosclerosis. You may also need to take medicine to reduce your blood cholesterol.2,4
  • If you smoke, quit. Talk with your doctor about ways to help you quit smoking.
  • You may need surgery to bypass blocked arteries.
  • A supervised exercise program is recommended for people with pain caused by too little blood flow to muscles to improve functional status, quality of life, and reduce leg symptoms.5

References

  1. Virani SS, Alonso A, Aparicio HJ, Benjamin EJ, Bittencourt MS, Callaway CW, et al. Heart disease and stroke statistics—2021 update: a report from the American Heart Association. Circulation. 2021;143:e254–e743.
  2. Creager MA, Loscalzo J. Chapter 275: Arterial Diseases of the Extremities. In: Jameson J, Fauci AS, Kasper DL, Hauser SL, Longo DL, Loscalzo J. eds. Harrison’s Principles of Internal Medicine, 20e. McGraw-Hill; Accessed August 28, 2020.
  3. Cohoon KP, Wennberg PW, Rooke TW. CHAPTER 96: DIAGNOSIS AND MANAGEMENT OF DISEASES OF THE PERIPHERAL ARTERIES. In: Fuster V, Harrington RA, Narula J, Eapen ZJ. eds. Hurst’s The Heart. 14e. McGraw-Hill; Accessed August 28, 2020.
  4. Gerhard-Herman MD, Gornik HL, Barrett C, et al. 2016 AHA/ACC Guideline on the Management of Patients With Lower Extremity Peripheral Artery Disease: Executive Summary: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines [published correction appears in 2017 Mar 21;135(12 ):e790]. Circulation. 2017;135(12):e686-e725.
  5. Gerhard-Herman MD, Gornik HL, Barrett C, et al. 2016 AHA/ACC Guideline on the Management of Patients With Lower Extremity Peripheral Artery Disease: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. J Am Coll Cardiol . 2016 Nov 8. pii: S0735-1097(16)36902-9.