If you have never heard of peripheral artery disease, or PAD, you are not alone. Yet approximately 6.5 million adults ages 40 and older in the United States have the condition. PAD is common, often overlooked and more serious than many people realize.

AD reduces blood flow to the legs and feet. Over time, that can make walking painful, slow the healing of wounds and increase the risk of heart attack and stroke. Advanced disease can also threaten the health of a leg or foot.

Jonathan Braun, MD, RPVI, a vascular surgeon with West Tennessee Medical Group Vascular Surgery, explains what patients should know about the warning signs, testing and treatment options.

What is peripheral artery disease?

Peripheral artery disease occurs when arteries that carry blood away from the heart become narrowed or blocked. PAD can affect the arms, but it most commonly affects the arteries that supply the legs and feet.

The usual cause is atherosclerosis, a buildup of fatty plaque inside the artery walls. As the opening inside an artery becomes smaller, less oxygen-rich blood reaches the muscles and tissues that need it.

PAD and coronary artery disease are closely related because both are commonly caused by atherosclerosis. The difference is where the narrowing occurs. Coronary artery disease affects the arteries that supply the heart, while PAD most often affects arteries in the legs. Having PAD may also be a sign that plaque is building up elsewhere in the body.

Who is at risk for PAD?

Anyone can develop PAD, but the risk is higher for people who:

• Smoke or have a history of tobacco use
• Have diabetes
• Have high blood pressure or high cholesterol
• Are older than 60
• Have chronic kidney disease
• Have a personal or family history of atherosclerosis, heart disease, stroke or PAD

Black adults are also affected by PAD at higher rates and may be diagnosed after the disease has become more advanced. Risk increases with age, but symptoms of PAD should not be dismissed as a normal part of getting older.

Signs of PAD that are easy to miss

The symptom most often associated with PAD is aching, cramping, heaviness or fatigue in the buttock, hip, thigh or calf that begins with walking or climbing stairs and improves after a few minutes of rest. This pattern is called intermittent claudication.

But not everyone has classic leg pain. The CDC notes that up to four in 10 people with PAD have no leg pain, which is one reason the condition can go undiagnosed. Other signs may include:

• One foot or lower leg that feels colder than the other
• Weakness, numbness or a pins-and-needles feeling in a leg or foot
• Skin that looks pale, bluish, smooth or shiny
• Decreased or absent pulses in the feet
• Slower growth of toenails or loss of hair on the legs
• Sores on the toes, feet or legs that heal slowly or do not heal
• Pain in the foot or leg while resting, which may signal more advanced disease

Leg pain has many possible causes, including arthritis, nerve problems and muscle strain. The pattern matters. PAD pain usually develops in the muscles during activity and improves with rest. Any recurring pain or change in a leg or foot deserves a conversation with a healthcare provider.

When to seek emergency care: Call 911 or seek immediate medical help if a foot or leg suddenly becomes very painful, pale or blue, cold, numb, or difficult to move. A sudden loss of blood flow is a medical emergency, and fast treatment may help save the limb.

How PAD is diagnosed

Diagnosis begins with a review of your symptoms, medical history and risk factors. Your provider may examine the skin on your legs and feet, check for wounds and compare the pulses in your legs.

The first test is often the ankle-brachial index, or ABI. This simple, painless test compares the systolic blood pressure in the ankle with the systolic blood pressure in the arm. A normal ABI is generally between 1.0 and 1.4. A result of 0.90 or lower is considered abnormal, while a result above 1.40 may also require further evaluation.

Depending on the results and your symptoms, additional testing may include a duplex ultrasound, CT angiography, MR angiography or a peripheral angiogram. These tests help the vascular team see where blood flow is limited and determine whether a procedure may be needed.

Treatment focuses on more than the legs

PAD treatment has several goals: easing symptoms, helping you stay active, lowering the risk of heart attack and stroke, preventing the disease from getting worse and protecting the affected limb. The right plan depends on your symptoms, overall health and the severity and location of the blockage.

For many people, treatment begins with a combination of:

• Stopping tobacco use. Smoking is one of the strongest risk factors for PAD and can make the disease progress more quickly.
• Structured exercise. A supervised exercise therapy program or another provider-guided walking plan can improve symptoms and increase how far you can walk.
• Managing related conditions. Keeping blood pressure, cholesterol and diabetes under control helps protect both the limbs and the heart.
• Taking prescribed medications. Your provider may recommend medicine to lower cholesterol, control blood pressure, reduce the risk of blood clots or improve walking symptoms.
• Caring for your feet. Check your feet regularly and report new sores, discoloration, drainage or signs of infection promptly, especially if you also have diabetes.

Do not start or stop aspirin, blood thinners or other medications without speaking with your healthcare provider. PAD treatment should be tailored to your health history and bleeding risk.

When a procedure or surgery may be needed

If symptoms continue to limit daily life despite medication and structured exercise, or if blood flow is so limited that a wound will not heal or tissue is at risk, a vascular procedure may be recommended.

Minimally invasive options may include angioplasty, in which a small balloon is used to open a narrowed artery, and stenting, in which a small mesh tube helps keep the artery open. In other cases, bypass surgery may be used to create a new path for blood around a blockage.

The goal is not simply to treat a test result. It is to improve blood flow, relieve symptoms, heal wounds when possible and preserve a functional limb. Your vascular surgeon will explain the benefits and risks of each option and recommend an approach based on your individual condition.

Do not wait for leg pain to become severe

PAD is treatable, and early attention matters. Talk with a healthcare provider if walking repeatedly causes pain or heaviness in your legs, one foot feels colder than the other, or a sore on your foot or leg is slow to heal. If you have diabetes or a history of smoking, ask whether PAD screening is appropriate even if your symptoms are mild.

West Tennessee Medical Group Vascular Surgery provides comprehensive care for PAD, from evaluation and long-term medical management to minimally invasive procedures and open vascular surgery when needed.

West Tennessee Medical Group Vascular Surgery provides comprehensive care for PAD, from evaluation and long-term medical management to minimally invasive procedures and open vascular surgery when needed. Concerned about your circulation? Schedule an appointment with West Tennessee Medical Group Vascular Surgery at 731-541-2250.

This article was first published on May 4, 2021