Peripheral artery disease, or PAD, is a common condition that occurs when blood flow to the periphery, or limbs, of the body is restricted by narrowed arteries. A little more than 118 million people worldwide were living with PAD in 2017. In the United States, about 6.5 million people over the age of 40 had been diagnosed with PAD in 2021. Learn more about this disease, including risk factors, symptoms, and treatment options.

What is peripheral artery disease?

PAD is the result of plaque build-up in the arteries, or atherosclerosis. The plaque, made up of cholesterol, calcium, and other substances found in our blood, causes the arteries to become very narrow, restricting the blood flow to areas of the body. In severe cases, the blood flow can be blocked completely. PAD largely affects the legs and the arms, but it can also impact the arteries to the abdomen and head.

Peripheral artery disease is commonly associated with coronary artery disease, which can lead to a heart attack, or cerebrovascular disease, which can lead to a stroke. The common denominator is atherosclerosis.

What causes peripheral artery disease?

Peripheral artery disease is caused by too much plaque in the blood vessels with thickening of the arterial walls and a decreased ability for blood to flow through the arteries. There are a variety of factors that can lead to plaque build-up in the arteries, including:

What are risk factors for PAD?

Anyone can be affected by plaque build-up in the arteries, though there are some hereditary risk factors that we can't control. Those include:

  • Age - about 11 percent of men and 9 percent of women in their 70s are diagnosed with PAD, while 26 percent of men and 20 percent of women in their 80s are diagnosed with PAD
  • Race - African Americans have a higher risk for developing PAD
  • Genetics - a family history of peripheral artery disease, cardiovascular disease, heart attack or stroke increases your likelihood of developing PAD

What are the symptoms of PAD?

The most common symptom of PAD is discomfort in the legs while walking, although the CDC estimates that 40 percent of patients with PAD have no leg pain. The pain associated with PAD can occur in the calf, back of the thigh, hip, or buttocks, and stops hurting when you stop walking or moving. Other symptoms include

  • hair loss on the affected limb
  • muscle weakness
  • wounds and sores that do not heal
  • especially pale toes or feet, or cold toes

Many people dismiss symptoms of PAD as being associated with aging or stiffness. If you notice these symptoms and have a history of high blood pressure, high cholesterol, or diabetes, talk with your doctor about these symptoms. The American Heart Association has a Peripheral Artery Disease Symptoms PDF you can fill out to check your symptoms before going to your doctor.

If your doctor suspects you have PAD, a very simple, noninvasive test can be done to confirm a diagnosis. The test is called the ankle brachial index (ABI) and measures the blood pressure in your ankles, then compares it to your blood pressure in your arms, both before and after exercise. Your doctor may also have diagnostic imaging ordered, including ultrasound, CT scans or angiography tests.

How is PAD treated?

Treatment for peripheral artery disease is mostly conservative, depending on the severity of the disease. Initially, lifestyle changes can help reduce the symptoms and prevent the disease from progressing. These lifestyle changes include:

  • smoking cessation, if you are a smoker
  • increased physical activity, either on your own or under the direction of a cardiovascular rehab program
  • moving to a heart-healthy diet, such as the DASH or Mediterranean diets
  • cholesterol medication such as statins
  • blood thinners like aspirin or Plavix
  • medications to control blood pressure and diabetes

Implementing these lifestyle changes can help prevent peripheral artery disease in many patients. In more advanced PAD treatment options include drug coated balloons, stent placement, bypass surgeries, or atherectomy (a minimally invasive procedure that removes plaque from the artery). At The Miriam Hospital, we've had success with a minimally-invasive procedure that cracks hard calcified plaque called intravascular lithotripsy (IVL) in arteries for patients with severe cases of peripheral artery disease or critical limb ischemia. 

If your primary care provider diagnoses you with peripheral artery disease, the Lifespan Cardiovascular Institute can help you learn more about the condition and how to manage it. Visit us online or call 1-855-332-8474.

Peter Soukas, MD

Peter A. Soukas, MD

Dr. Peter A. Soukas is the director of the Lifespan Cardiovascular Institute peripheral vascular interventional laboratory at The Miriam Hospital and specializes in carotid stenting and the treatment of lower extremity disease.