Ten million Americans suffer from arteriosclerosis – fatty deposits in the arteries, which lead to narrowing of the vessels and peripheral arterial disease, or PAD.  PAD is the leading cause of disability among men and women over age 50, as well as those with diabetes.

About Peripheral Arterial Disease

Peripheral Arterial Disease, or PAD, is a condition of the blood vessels that leads to narrowing and stiffening of the blood vessels that supply the organs in the body. This includes the legs, brain and kidneys, but also can affect the intestines and other structures such as the arms. This narrowing leads to decreased blood flow, which can decrease function and even cause the organs to die.

Causes, Incidence and Risk Factors

Peripheral Arterial Disease is caused by arteriosclerosis, commonly referred to as “hardening of the arteries.” This problem occurs when fat and other debris known as plaque builds up on the walls of your arteries. This causes the arteries to become narrower and they also become stiffer and cannot widen to allow greater blood flow when needed. As a result, when the muscles of your legs are working harder they cannot get enough blood, oxygen and other nutrients. In many patients, there may not be enough blood and oxygen, even when the muscles are resting. This can lead to pain and even gangrene (death of tissues).

PAD is common and usually affects people over age 50. Risk factors include:

  • Abnormal cholesterol (dyslipidemia)
  • Diabetes
  • Heart disease (coronary artery disease)
  • High blood pressure
  • Kidney disease
  • Smoking
  • Stroke

Symptoms and Signs

The classic symptoms are pain, achiness, fatigue, burning, or discomfort in the muscles of your feet, calves, or thighs. These symptoms usually appear during walking or exercise and go away after several minutes of rest.

At first, these symptoms may appear only when you walk uphill, walk faster, or walk for longer distances.
Slowly, these symptoms come on more quickly and with less exercise. Your legs or feet may feel numb when you are at rest. The legs also may feel cool to the touch, and the skin may appear pale.
When peripheral artery disease becomes severe, you may have:

  • Erectile dysfunction/impotence
  • Pain at rest
  • Pain or tingling in the feet or toes, even the weight of clothes or bed sheets can be painful
  • Pain that is worse when the leg is elevated and improves when you dangle your legs down
  • Ulcers that do not heal

During an examination, the healthcare provider may find:

  • A whooshing sound with the stethoscope over the artery (arterial bruits)
  • Decreased blood pressure in the affected limb
  • Loss of hair on the legs or feet
  • Weak or absent pulses in the limb

When PAD is more severe, findings may include:

  • Calf muscles that shrink (wither)
  • Hair loss over the toes and feet
  • Painful, non-bleeding ulcers on the feet or toes (usually black) that are slow to heal
  • Paleness of the skin or blue color in the toes or foot
  • Shiny, tight skin
  • Thick toenails

Blood tests may show abnormal cholesterol, diabetes or a condition known as homocysteinemia.