What Is Peripheral Artery Disease?

Peripheral artery disease (PAD) can sometimes go undetected, so it's important to know the symptoms. Plus, learn about the possible complications of PAD and how the condition is treated.

Restricted blood flow anywhere in your body can be a serious health problem that can ultimately affect your heart. When blood flow to the legs is reduced, the condition is called peripheral artery disease, or PAD, explains Joshua A. Beckman, MD, director of the Cardiovascular Fellowship Program at Brigham and Women's Hospital and assistant professor at Harvard Medical School in Boston. PAD occurs when arteries in the legs become hardened due to the build-up of plaque (cholesterol and other fatty substances) — a condition called atherosclerosis.

Who Develops PAD
"PAD often develops in people who smoke or have diabetes," says Dr. Beckman. In addition, it is commonly found in people who are between the ages of 50 and 69. In people above the age of 65, approximately 20 percent of men and 16 percent of women have PAD.

Other risk factors for PAD include:
Having high blood pressure
Having high cholesterol
Having a history of heart disease
Undergoing hemodialysis to treat kidney disease
Having had a stroke

"About half of the people who have PAD do not have specific symptoms and have no way to know they have the disease," says Beckman. "Of the half that do have symptoms, the majority describe feeling discomfort in an area like the calf, hip or thigh while walking."

If you have any of the risk factors for PAD, you should ask your doctor about PAD even if you aren’t experiencing symptoms. Your doctor can still diagnose PAD through one or more tests.

Signs of PAD
The pain people with PAD experience while walking is called intermittent claudication. You may feel a burning, aching, heaviness, or leaden feeling because the exercising muscle is demanding more blood than can be delivered due to poor blood flow in the legs. "The discomfort occurs only with walking and is typically relieved with a few minutes of rest," says Beckman.

It can be easy to discount this pain as arthritis, a result of aging, or an injury from exercise. But if you continue to notice these symptoms when you walk, and they stop when you rest, PAD could be the reason.

When PAD worsens and blood flow is severely restricted, the feet and legs may be painful even without exercise.

Risks of Untreated PAD
Untreated PAD can lead to heart attack or stroke. People with untreated PAD are six to seven times more likely to experience heart attack or stroke than those without the disease. Beckman estimates that the risk of death in those with untreated PAD is 15 to 30 percent over five years.

Amputation is also a risk of untreated PAD, though it isn't common in either people who do not experience PAD symptoms or in those who experience intermittent pain. But between 1 and 2 percent of people with PAD may either experience severe pain in their legs while resting, a wound on their foot that won't heal, or even gangrene, says Beckman. Then amputation is a more serious threat unless action is taken.

Treating PAD
Treatment for PAD usually entails a combination of prescribed medication and a healthier lifestyle to manage atherosclerosis, lower cholesterol and blood pressure levels, and improve blood flow in your legs.

Here are steps your doctor may recommend to treat and manage PAD:

Quit smoking
Take medications to manage contributing health problems, like high cholesterol and high blood pressure
Take anti-clotting medications to prevent blood clots
Walk and get other exercise frequently
Achieve and maintain a healthy body weight
Eat a healthy diet of low-cholesterol, low-fat, and low-calorie foods

In some cases, blockages in the legs may need to be opened up with a catheter in a procedure called angioplasty and propped open with a small tube called a stent. In cases of severe PAD, bypass surgery may be needed to reroute blood flow in the legs.


By Diana Rodriguez
Medically reviewed by Pat F. Bass III, MD, MPH