Peripheral Arterial Disease- PAD

Peripheral artery disease (PAD) is a narrowing of the arteries in the legs which limits mobility, causes pain and creates poor circulation. The symptoms may occur in any part of the legs from the thighs to the feet. PAD is relatively common, affecting more than 10 million people in the U.S. It is more common in people who are 65 or older, but can occur at nearly any age.


Fatigue or cramping of your muscles (claudication) in the calf, thigh, hip, or buttock may signal you have PAD. Typically, the discomfort is felt after walking a certain distance and goes away with rest. The severity of claudication varies widely, from mild discomfort to debilitating pain. Severe claudication can make it hard for you to walk or do other types of physical activity. Other symptoms may also include:

  • Leg numbness or weakness
  • Coldness in your lower leg or foot, especially when compared with the other side
  • Sores on your toes, feet or legs that won’t heal
  • A change in the color of your legs
  • Hair loss or slower hair growth on your feet and legs
  • Slower growth of your toenails
  • Shiny skin on your legs
  • No pulse or a weak pulse in your legs or feet


Peripheral artery disease is often caused by fatty deposits (plaques) building up in your artery walls and reducing blood flow. Risk factors include smoking, high cholesterol, high blood pressure, diabetes, kidney disease and obesity. Genetic factors also play a role, but are not well understood.


The vascular surgeon will perform a physical exam and ask questions about your symptoms and medical history. An initial diagnostic test for PAD is the ankle brachial index (ABI). The test involves taking a blood pressure reading at the ankle and comparing it to that in the arm. Sometimes, an angiogram is done to determine where in the arteries plaque has built up to assess treatment options. This can be done using a CT or MRI, or possibly by doing a catheter-directed angiogram, which involves placing a thin tube into the artery and injecting dye into the arteries to see where the blockages are located.


PAD is usually treated by aggressively managing the risk factors with lifestyle changes and medication. This includes quitting smoking, controlling blood pressure and cholesterol, managing diabetes and losing weight. In addition, an exercise program, if followed faithfully, can significantly improve the symptoms of PAD in many cases.

If PAD is causing serious symptoms, further treatments such as balloon angioplasty, stent placement, or surgical bypass can be very effective in improving the blood flow to the affected leg.