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Frequently Asked Questions

What is Peripheral Artery Disease?

Short Answer

Narrowing of the arteries in areas away from the heart and brain.

Long Answer

Atherosclerosis is narrowing and hardening of the arteries in any part of the body due to a buildup of fatty deposits (plaque) along the artery walls. Peripheral artery disease (PAD) refers to narrowing of the arteries located in parts of the body outside of the heart and brain. It is usually caused by atherosclerosis.

PAD reduces the amount of oxygenated blood flowing to peripheral arteries, some of which are shown in the diagram below.

Arteries that can be affected by peripheral artery disease

PAD is a serious condition that can cause pain, numbness, infection, and even gangrene in the extremities. If treated early enough, however, it can be controlled and sometimes reversed.

Risk Factors

  • Smoking or a history of smoking (major risk factor)
  • Diabetes mellitus (major risk factor)
  • Age, especially after age 50
  • Obesity
  • Physical inactivity
  • Personal or family history of:
  • African Americans are at a higher risk than Caucasians or Asians.

Symptoms

Many people with PAD experience no symptoms or mild symptoms that they chalk up to something else like the normal effects of aging. It's important to bring symptoms to your doctor's attention, especially if you have any of the risk factors. The presence of PAD puts you more at risk for heart disease and stroke.

For those who do experience symptoms, most have pain and numbness in the legs (and less often the arms) during walking or other exercise that subsides when at rest. This is called intermittent claudication which we discuss in more depth in a separate FAQ.

Diagnosis

Your doctor will discuss your symptoms, your medical history and that of your family, and then perform a physical exam. Based on your symptoms, this may include checking for weak arterial pulses in the arms or legs, listening for abnormal sounds in the arteries using a stethoscope, and looking for changes in skin or nail colour.

If your doctor suspects you have peripheral artery disease, he or she may perform a simple test called the ankle-brachial index (ABI) which compares blood pressure readings of the ankles and arms. In a healthy person, ankle pressure is at least 90% of that in the arms. In someone with PAD, ankle pressure can be less than 50%.

Further tests may be ordered such as:

  • Blood tests to check for high blood pressure, high cholesterol levels, and kidney function
  • A Doppler ultrasound test to measure blood flow and detect blockages
  • A Pulse Volume Recording (PVR) in which blood pressure readings are taken at various points on the arms and legs
  • Computed Tomographic Angiography (CTA) to examine arteries and blood flow using x-rays
  • Magnetic Resonance Angiography (MRA) provides similar information to a CTA without the use of x-rays
  • Treadmill test

Treatment

The goals of treatment are to reduce symptoms, such as leg pain, and stop the progression of atherosclerosis.

There are things you can do yourself to help control the underlying atherosclerosis as well as lower blood pressure and cholesterol levels:

  • Quit smoking. You're four times more likely to develop PAD if you smoke or have a history of smoking.
  • Eat a healthy diet high in fiber and low in fats and cholesterol.
  • Exercise regularly.

If needed, your doctor may prescribe medication to lower your blood pressure, lower your cholesterol levels, prevent blood clots, and lower blood glucose levels if you have diabetes.

To increase blood flow to the limbs and reduce the painful symptoms of intermittent claudication, your doctor may prescribe Cilostazol (Pletoz, Pletal) or Pentoxifylline (Trental).

In severe cases of PAD, angioplasty or surgery may be recommended.

Additional Information

What Is Peripheral Arterial Disease? (nhlbi.nih.gov)
The U.S. National Institutes of Health covers a variety of topics related to PAD with links to related topics.
Peripheral artery disease (PAD) (MayoClinic.org)
The Mayo Clinic offers comprehensive information about PAD as well as a advice on preparing for your doctor's appointment and what to expect.
Peripheral Vascular Disease (PVD, Peripheral Artery Disease, Peripheral Arterial Disease, PAD) (MedicineNet.com)
MedicineNet.com has a number of articles about PAD including information about supervised exercise, angioplasty and surgery for PAD.
Peripheral Artery Disease (PAD) (scai.org)
This public education website, hosted by the Society for Cardiovascular Angiography and Interventions, covers a variety of cardio-vascular topics including peripheral artery disease. The links at the bottom of the page go to basic information about PAD as well as to a goal-setting planner, risk flowchart, and foot care advice.
Peripheral Artery Disease (PAD) (VascularWeb.org)
The Society of Vascular Surgery provides an illustrated summary of PAD along with a series of podcasts by vascular surgeons about PAD.
Peripheral Arterial Disease (PAD) Overview (ClevelandClinic.org)
The doctors at the Cleveland Clinic cover basic PAD information as well as related conditions.
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