Peripheral artery disease
What is Peripheral artery disease?
Peripheral artery disease, or PAD, happens when fatty deposits build up in arteries outside your heart. These plaques narrow blood vessels that carry oxygen-rich blood to your legs, arms, stomach, or head. When arteries get too narrow, your muscles and tissues don't get enough blood flow.
PAD most often affects the legs and feet. You might notice pain when walking that goes away when you rest. This happens because your leg muscles need more oxygen during activity, but narrowed arteries can't deliver enough blood. Over time, severe PAD can cause wounds that won't heal or even tissue death.
About 8 to 12 million Americans have PAD. It's most common in people over 65, but smokers and people with diabetes can develop it much younger. PAD is a warning sign that fatty deposits may be blocking arteries in other parts of your body, including your heart and brain.
Symptoms
- Pain, cramping, or heaviness in leg muscles when walking or climbing stairs
- Pain that goes away after a few minutes of rest
- Coldness in one leg or foot compared to the other
- Numbness or weakness in the legs
- Sores or wounds on toes, feet, or legs that heal slowly or not at all
- Color changes in the skin of legs or feet
- Shiny skin or hair loss on legs and feet
- Weak or absent pulse in legs or feet
- Erectile dysfunction in men
Many people with early PAD have no symptoms at all. Some people dismiss leg pain as a normal part of aging. Getting your cholesterol checked regularly helps catch PAD risk before symptoms appear.
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Causes and risk factors
PAD develops when cholesterol, fat, and other substances build up in artery walls. This process is called atherosclerosis. High LDL cholesterol is a major cause because it accumulates in arteries and forms hard plaques. These plaques make arteries narrow and stiff. Smoking damages artery walls and speeds up plaque buildup. High blood pressure and high blood sugar also injure arteries over time.
Your risk increases if you smoke, have diabetes, have high cholesterol, or have high blood pressure. Age matters too, with risk rising after 65. Family history of heart disease or stroke raises your chances. Being overweight, being physically inactive, and having chronic kidney disease also contribute to PAD risk.
How it's diagnosed
Doctors diagnose PAD through physical exams and specialized tests. They'll check pulses in your legs and feet and compare blood pressure in your arms and ankles. An ankle-brachial index, or ABI, measures blood pressure at your ankle divided by blood pressure at your arm. An ABI below 0.90 suggests blocked arteries. Ultrasound imaging can show blood flow and find narrowed sections of arteries.
Blood tests help identify risk factors that cause PAD. Checking your LDL cholesterol level shows if you have too much of the type of cholesterol that clogs arteries. Your doctor may also order tests for blood sugar and kidney function. Talk to a doctor about which tests you need based on your symptoms and risk factors.
Treatment options
- Quit smoking, the single most important step to slow PAD progression
- Walk regularly to build new blood vessels and improve symptoms
- Eat a diet low in saturated fat and high in vegetables, fruits, and whole grains
- Manage blood sugar if you have diabetes
- Take statins to lower LDL cholesterol and stabilize plaques
- Take blood pressure medications if needed
- Take aspirin or other medications to prevent blood clots
- Consider cilostazol to reduce leg pain during walking
- Get angioplasty or surgery to open severely blocked arteries
Frequently asked questions
Most people with PAD feel cramping, pain, or heaviness in their leg muscles when walking. The pain typically starts in the calf, thigh, or buttocks during activity and goes away within minutes of rest. Some people describe it as tired or heavy legs. Many people with early PAD have no symptoms at all.
PAD cannot be fully cured, but it can be managed and even improved with treatment. Quitting smoking, exercising regularly, and lowering cholesterol can slow or stop the disease. Some people see their symptoms improve significantly with lifestyle changes and medication. Severe blockages may require procedures to restore blood flow.
PAD and heart disease are caused by the same process of cholesterol building up in arteries. PAD affects arteries in the legs, arms, or other areas outside the heart. Heart disease affects arteries that supply the heart muscle itself. Having PAD means you're at higher risk for heart attack and stroke.
Untreated PAD can lead to severe complications over time. Pain may become so bad that walking even short distances is impossible. Wounds on feet or legs may not heal and can become infected. In the worst cases, tissue death requires amputation. People with PAD also face higher risk of heart attack and stroke.
Yes, exercise is actually one of the best treatments for PAD. Walking regularly helps your body grow new small blood vessels around blockages. Start slowly and walk until you feel pain, rest until it goes away, then walk again. Over time, you should be able to walk farther before pain starts.
Avoid foods high in saturated fat, trans fat, and cholesterol because they raise LDL cholesterol and worsen plaque buildup. This includes fatty red meat, full-fat dairy, fried foods, and processed snacks. Limit salt to help control blood pressure. Cut back on sugar, especially if you have diabetes or prediabetes.
High LDL cholesterol is a major cause of PAD because it forms plaques in artery walls. A blood test measuring direct LDL shows your level of this harmful cholesterol. If your LDL is above 100, you have increased risk. Your doctor can help you understand your results and whether your cholesterol needs treatment.
PAD itself is not directly inherited, but risk factors that cause it can run in families. If your parents or siblings have heart disease, high cholesterol, high blood pressure, or diabetes, your risk is higher. Family history of early heart attacks or strokes also increases your PAD risk. Lifestyle choices still play a huge role regardless of genetics.
Yes, losing excess weight can help manage PAD in several ways. Weight loss often lowers LDL cholesterol, blood pressure, and blood sugar, all of which damage arteries. It reduces stress on your heart and makes physical activity easier. Even losing 5 to 10 percent of your body weight can make a meaningful difference.
See a doctor if you have leg pain that happens when you walk and goes away with rest. Also get checked if you have wounds on your feet or legs that won't heal. Sudden severe leg pain, coldness, or color changes need immediate medical attention. These could mean a complete artery blockage requiring emergency treatment.