Peripheral Artery Disease

What is peripheral artery disease?

Peripheral artery disease (PAD) is a slow and progressive circulation disorder caused by narrowing, blockage or spasms in a blood vessel.

PAD may affect any blood vessel outside of the heart including the arteries, veins and lymphatic vessels. Organs supplied by these vessels, such as the brain, may not get enough blood flow for proper function; however, the legs and feet are most commonly affected.

Peripheral artery disease is also called peripheral arterial disease. 

Causes of peripheral artery disease

The most common cause of PAD is atherosclerosis, the buildup of plaque inside the artery wall. Plaque reduces the amount of blood flow to the limbs. It also decreases the oxygen and nutrients available to the tissue. Blood clots may form on the artery walls, further decreasing the inner size of the blood vessel and blocking off major arteries.

Other causes of PAD may include:

• Injury to the arms or legs
• Irregular anatomy of muscles or ligaments
• Infection

People with coronary artery disease often also have PAD. 

Risk factors for peripheral artery disease

A risk factor increases your chance of developing a disease. Some can be changed, others cannot. Risk factors for PAD that you can’t change:

• Age (especially older than age 50)
• History of heart disease
• Male gender
• Postmenopausal women
• Family history of high cholesterol, high blood pressure or peripheral artery disease

Risk factors that may be changed or treated include:

• Coronary artery disease
• Diabetes
• High cholesterol
• High blood pressure
• Overweight
• Physical inactivity
• Smoking or use of tobacco products

Those who smoke or have diabetes have the highest risk of complications from PAD because these risk factors also cause impaired blood flow. 

Symptoms of peripheral artery disease

About half the people diagnosed with PAD are symptom free. For those with symptoms, the most common first symptom is painful leg cramping that occurs with exercise and is relieved by rest.

Other symptoms of PAD may include:

• Changes in the skin, including decreased skin temperature, or thin, brittle, shiny skin on the legs and feet
• Weak pulses in the legs and the feet
• Gangrene (dead tissue due to lack of blood flow)
• Hair loss on the legs
• Impotence
• Wounds that won't heal over pressure points, such as heels or ankles
• Numbness, weakness or heaviness in muscles
• Pain (described as burning or aching) at rest, commonly in the toes and at night while lying flat
• Paleness when the legs are elevated
• Reddish-blue discoloration of the extremities
• Restricted mobility
• Severe pain when the artery is very narrow or blocked
• Thickened, opaque toenails

See your health care provider for a diagnosis. 

Treatment of peripheral artery disease

The main goals for treatment of PAD are to control the symptoms and halt the progression of the disease to lower the risk for heart attack, stroke and other complications.

Treatment may include:

• Lifestyle changes to control risk factors, including regular exercise, proper nutrition and quitting smoking
• Aggressive treatment of existing conditions that may worsen PAD, such as diabetes, high blood pressure and high cholesterol
• Medicines to improve blood flow, such as blood thinners, and medicines that relax the blood vessel walls
• Vascular surgery — a bypass graft using a blood vessel from another part of the body or a tube made of synthetic material is placed in the area of the blocked or narrowed artery to reroute the blood flow 
• Angioplasty — your doctor inserts a catheter (long hollow tube) to create a larger opening in an artery to increase blood flow.

Vascular care is offered at some of our hospitals. If you need more specialized vascular care, you have access to services at our Heart and Vascular Center, located at UMass Memorial Medical Center in Worcester, MA.