Peripheral Arterial Disease

Effects of ‘atherosclerosis’ (hardened fat deposits lining the walls of blood vessels) depends on the part of the body affected. Peripheral arterial disease or PAD is one such effect of atherosclerosis wherein the blood supply to the arms, pelvis or legs is hampered due to plaque formation.

In atherosclerosis, there is a predominant narrowing of the blood vessel lumen when a plaque that is made up of fat, cholesterol, calcium, fibrous tissue and other substances in the blood builds up along the vessel wall.

Obstruction of the blood vessels interferes with the oxygen and normal blood supply to the part supplied. If not treated on time, the condition can progress to cause death of the involved tissue or organ, and result in gangrene of the part.

When PAD affects the blood vessels of your leg, you may initially experience painful cramping in your leg, hip, thigh or calf muscles after walking or climbing stairs. This may deteriorate, and you may experience pain in your feet and toes even at rest.

Wounds in your leg may get infected and show very slow healing. You may also experience leg numbness or weakness, coldness in the affected foot, difficult to heal sores, change in the color of your legs (blackening of skin), hair loss or slower hair growth on your feet and legs, slower growth of your toenails, shiny skin on your legs, and erectile dysfunction in men.

Claudicating knocks first

The hallmark symptom of PAD is claudication. It is s a medical term derived from the Latin term ‘claudicare’ that means ‘to limp’. It typically describes pain in the leg, calf, thigh, or hip on walking, running or climbing stairs.

The factor that distinguishes it is that it almost always gets relieved by rest. Initially you would experience something called as intermittent claudication that happens as the narrowing of the artery usually occurs gradually, causing intermittent pain.

As the muscle’s demand for blood and oxygen increases during exercise, you experience the pain as the blood supply doesn’t match the demand. On resting the muscle’s need for blood lessens, and the pain goes away. ”

Claudication progresses to the second stage of PAD, if narrowing of the blood vessels deteriorates and is then termed as CLI (chronic limb ischemia) that includes pain even at rest or while seated and has potential to lead to gangrene.

Patients with buttock claudication will frequently stop walking until the pain goes away and is also known as “window shopper’s disease.

PAD and you

You are at a high risk of developing PAD or claudication, if you are an elderly person with uncontrolled blood sugars, high blood pressure, and high cholesterol levels.

It could also develop if you suffer from a condition termed as atherosclerosis (hardened fat deposits lining the walls of blood vessels). However, you may need to be overly cautious if you are a chronic smoker as the risk is increased four times as compared to others.

Other factors that increase your risk of PAD are obesity, sedentary lifestyle, and a family history of heart attack, heart disease or stroke.


There are a few peripheral artery disease symptoms mentioned below. They are:

  • Painful cramps in hip, calf muscles, thigh region
  • Leg weakness and numbness
  • Sores on the foot
  • Change in the color of the legs
  • Hair loss on the feet
  • Slower growth of toenails
  • Shiny skin on the legs
  • Erectile dysfunction in men

Your physician needs to evaluate you

Your physician will evaluate you for the complaints of leg pain particularly on walking or exercising that disappears after a few minutes of rest, numbness, tingling, or coldness in the lower legs or feet, sores or infections on your feet or legs that heal slowly.

Your physician would also examine your pulses in the blood vessels in your legs or listen to the blood flow with a stethoscope or a small device called Doppler. He might find low or no pulse sounds beyond the level of blockage.

Your physician will then confirm the diagnosis by doing the ankle brachial index (ABI) test. With this test he will compare the blood pressure in your ankle to the blood pressure in your arm. If the blood pressure in the lower part of your leg is lower than the pressure in your arm, it would be suggestive of PAD. Although this may confirm the diagnosis of PAD your physician would further recommend tests to identify the vessel affected and the level of block.

The other tests needed to confirm a diagnosis of PAD include a special ultrasound imaging technique called the Doppler ultrasound for the lower limbs (helps evaluate the blood flow through your blood vessels and also identification of blocked or narrow arteries) , arteriography or x-ray of the limbs after injection of a dye into the blood vessel, computed tomography angiography (CTA)/ magnetic resonance angiography (MRA) to detect blockages within blood vessels, and ultrasound to produce images of the blood vessels on a screen using sound waves.

Don’t lose hope – PAD is treatable

Although PAD is a serious condition, it is treatable if you seek medical advice as early as possible. Your physician will plan out a management plan that will basically attempt to provide relief from pain, and also try to prevent progression of the plaque.

The most important lifestyle changes needed to be done by you are to quit smoking, maintain a scheduled exercise regimen, and eat a healthy diet low in saturated and trans fat and oils.

Medicines prescribed by your doctor will include drugs to prevent clots, lower your blood pressure, lower your levels of cholesterol, and control your blood sugars, drugs for healing of infected or open wounds and to provide pain relief.

Although surgery may not be the first option in the management of the condition, it may become necessary if the block in your vessel is severe enough to cause damage to the tissue.

Surgical procedures that are done to treat PAD include angioplasty, artery bypass graft, endarterectomy, and grafting.

In angioplasty a small tube with a balloon attached is inserted and threaded into an artery. The balloon is then inflated to help open the narrowed artery. Your surgeon may also place a wire tube or stent in place to help keep the artery open.

In artery bypass graft: a blood vessel is taken from another part of the body and is attached to bypass a blocked artery. Or a section of the blocked artery may be replaced with a graft (of another vein or artificial blood vessel) to remove the block.

In endarterectomy the surgeon cleans up the plaque buildup inside the artery of the affected leg or arm.

All these are the peripheral vascular treatments offered to the people suffering from peripheral artery disease.