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Peripheral Artery Disease (PAD) - Overview

Around 6.5 million people aged 40 and older in the United States have peripheral artery disease (PAD). This common yet serious vascular disease can cause painful and uncomfortable leg symptoms. Over time, PAD can impact mobility and quality of life. It can also increase your risk of heart attack, stroke, and limb amputation.

Early treatment is recommended to prevent the progression of PAD. At USA Vascular Centers, a vascular specialist can work with you to develop a personalized treatment plan. Our specialists are experts in treating vascular conditions and are dedicated to improving patients’ quality of life.

Signs and Symptoms of PAD

It is important to recognize peripheral artery disease's early signs and symptoms.

The most common peripheral artery disease symptom is intermittent claudication, experienced by about one-third to one-half of all people with PAD.² Intermittent claudication is muscle pain, weakness, or heaviness that begins with physical activity such as walking, and stops within minutes after resting. Over time, untreated PAD could result in constant claudication pain and critical limb ischemia, a condition that can lead to leg amputation. This is why it’s important to see a vascular doctor if you suspect your calf, leg, thigh, or buttock pain while walking may be due to PAD.

A variety of other leg symptoms affect people with PAD. However, many PAD patients have no symptoms at all.¹ In addition to claudication, symptoms of peripheral artery disease include loss of leg hair, skin discoloration, shiny skin on the legs, slowed toenail growth, cold or numb toes, and non-healing wounds on the feet or legs. If you notice any of these symptoms, we encourage you to seek a consultation and testing with one of our skilled vascular doctors.

Most Common Early Warning Signs of Peripheral Artery Disease

Intermittent claudication is the most common early warning sign of PAD. However, many patients will initially brush off the achy, tired legs as a typical sign of aging. Loss of hair on the legs and toenail growth that seems to slow down can also be early warning signs of PAD. As with intermittent claudication, these peripheral artery disease symptoms can often go ignored.

The good news is that awareness of these symptoms of peripheral artery disease goes a long way toward treating PAD and keeping it from becoming more severe. You may feel nervous when you notice intermittent claudication or hair loss on your legs, but with treatment, you can continue to live a full and active life even with PAD.

Advanced Symptoms

When PAD goes untreated, it can advance, leading to more noticeable symptoms. Intermittent claudication can develop into constant pain, even while you are at rest. This is a sign of critical limb ischemia (CLI). CLI is advanced PAD, where the condition has worsened so that the arteries are suffering from a severe blockage of blood flow in one or more places. The toes, legs, and feet may be in constant pain or numb. Sores can develop and linger for months or never heal at all. Without adequate oxygen-rich blood flowing to the lower extremities, the body cannot heal itself. 

How Fast Can PAD Develop?

Young people may not feel like they need to worry about preventing peripheral artery disease, but many PAD cases develop slowly as people progress toward middle age.³ The arteries become stiffer, and plaque can build up due to genetics and lifestyle choices until it begins to cause symptoms, such as claudication.

However, once the arteries are impacted enough to show up on diagnostic tests, symptoms can progress rapidly.² The American College of Cardiology and the American Heart Association recommends that individuals 65 years of age or over undergo PAD screening regardless of risk factors. If you are 50 years old or older and have any PAD risk factors, the ACC and AHA recommend undergoing screening. Adults younger than 50 with diabetes and one additional PAD risk factor should get screened as soon as possible.

Serious Complications of Poor Circulation

When peripheral artery disease treatment is delayed, PAD can progress to critical limb ischemia. CLI requires urgent treatment to help avoid complications of poor circulation, including tissue death caused by a lack of blood flow (gangrene). Left untreated, CLI can result in amputation or even loss of life

If you are worried you may have advanced claudication or critical limb ischemia, see one of our compassionate vascular doctors right away. Our empathetic, highly trained doctors can help you understand your PAD symptoms and work with you to develop a personalized care plan. 


Causes and Risk Factors for PAD

Your arteries are responsible for carrying blood and oxygen throughout the body. PAD is caused by plaque buildup in the arteries, known as atherosclerosis. Plaque is composed of cholesterol, fats, cellular waste products, and fibrin. Atherosclerosis can lead to a narrowing or blockage of blood flow in the arteries leading to the lower extremities. 

Smoking, diabetes, high cholesterol, and high blood pressure are notable risk factors for PAD. If you currently smoke, we encourage you to start the journey to a smoking-free life. Those with diabetes should take care to manage their condition carefully, and anyone with high cholesterol or blood pressure should speak to their doctor to find out how best to reduce the risk of PAD. 

Other contributing factors that can help determine whether a person develops PAD are a family history of atherosclerosis or PAD, chronic kidney disease, being overweight, and living a sedentary lifestyle.

If you are concerned that you have one or more of these risk factors, talk to a vascular doctor to learn how to minimize your risk of PAD or treat existing peripheral artery disease symptoms


PAD Diagnosis and Tests

If you are at risk for PAD, your doctor may order medical tests to make a diagnosis. At USA Vascular Centers, we use the following tests to diagnose PAD:

  • Ankle-brachial index (ABI): Most commonly, an ABI exam is used to diagnose PAD. This minimally invasive test takes only a few minutes and compares the blood pressure in your ankle with that of your arm.
  • Angiogram: Angiography is medical imaging that involves injecting a contrast agent (a type of dye) into the arteries. Afterward, X-ray images are taken to measure blood flow and look for arterial blockages that indicate PAD.

Stages of PAD

Peripheral artery disease is considered a progressive disease. This means symptoms worsen over time, leading to more serious health conditions. Without treatment, your disease may progress in the following ways:

  • Early disease: It is possible to have PAD and not be aware of it since some individuals do not experience symptoms during the early stages. Others begin to notice mild symptoms, such as intermittent claudication.
  • Moderate disease: As PAD progresses, the symptom of claudication may become severe and impact daily activities. You may experience leg pain at rest or skin changes like discoloration and non-healing wounds. In severe cases, critical limb ischemia (CLI) can develop. CLI is a vascular condition that occurs when an adequate blood supply fails to reach one or more limbs. When left untreated, it can result in limb amputation. 
  • Advanced disease: When PAD progresses to the advanced stages, treatment options are limited. Limb amputation may be required due to tissue death and dry gangrene (dry, black skin). 

Peripheral Artery Disease Prevention

If you are at risk for PAD, we recommend controlling your lifestyle risk factors to prevent disease onset. Specifically, we suggest you:

  • Eat a healthy, well-rounded diet,
  • Be physically active
  • Quit smoking
  • Manage underlying health conditions
  • Attend routine health screenings

If you are struggling to achieve a healthy lifestyle, talk to your doctor about available resources. They may recommend visiting a registered dietician, participating in a supervised exercise program, or joining a smoking cessation program.

PAD Management and Lifestyle

Chronic peripheral artery disease can impact your quality of life. Although there is no cure, PAD is a treatable condition. We also want you to understand that early treatment leads to the best health outcomes.

Your personalized PAD treatment plan may include:

  • Lifestyle modifications: Maintaining a healthy Body Mass Index (BMI), eating a well-rounded diet, exercising regularly, and quitting smoking can help alleviate your PAD symptoms and also help prevent dangerous health complications.
  • Medications: Your doctor may prescribe medications to improve blood flow throughout the body. Be sure to take these exactly as prescribed.
  • Medical procedures: In the case of a severe blockage, we may recommend a vascular procedure to open up your arteries. Our specialists are renowned experts in performing minimally invasive PAD treatments.

At USA Vascular Centers, all of our PAD treatments aim to alleviate symptoms, reduce health risks, and improve quality of life. 

When Should I Schedule a Visit to See a Vascular Doctor?

If you are at risk for peripheral artery disease or are experiencing PAD symptoms, we recommend consulting a vascular doctor as soon as possible. At USA Vascular Centers, our doctors perform three minimally invasive procedures that help open narrowed arteries: angioplasty, stent placement, and atherectomy. These procedures generally take just two hours from the start of your appointment to the end of your supervised recovery time. Treatment can help reduce your PAD symptoms and return to the activities you love best. 

Request a Consultation With USA Vascular Centers

Our leading vascular specialists offer lower extremity peripheral artery disease treatment. Office-based appointments are available in over 40 locations nationwide. We also provide virtual doctor visits.

To explore your treatment options, schedule an appointment today. We look forward to meeting you.

Sources Cited

[1] “Peripheral Artery Disease and Intermittent Claudication.” Mount Sinai Health System. Accessed March 16, 2022. https://www.mountsinai.org/health-library/report/peripheral-artery-disease-and-intermittent-claudication

[2] “Heart Health and Aging.” National Institute on Aging. U.S. Department of Health and Human Services. Accessed March 16, 2022. https://www.nia.nih.gov/health/heart-health-and-aging

[3] Mohler ER; Bundens W; Denenberg J; Medenilla E; Hiatt WR; Criqui MH; “Progression of Asymptomatic Peripheral Artery Disease over 1 Year.” Vascular medicine (London, England). U.S. National Library of Medicine. Accessed March 16, 2022. https://pubmed.ncbi.nlm.nih.gov/22363014/

[4] “Screening for Pad and CVD Risk with ABI: USPSTF RECOMMENDATION.” American College of Cardiology. Accessed March 16, 2022. https://www.acc.org/latest-in-cardiology/ten-points-to-remember/2018/07/11/14/31/screening-for-peripheral-artery-disease-and-cardiovascular-disease

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