What Is Peripheral Artery Disease?
Peripheral artery disease, or PAD, happens when plaque buildup causes narrowing or blockage of the arteries that carry blood from the heart to the limbs. “Peripheral” refers to any part of the body other than the heart or brain. The condition often affects the extremities — the arms, hands, legs and feet.
PAD is a type of peripheral vascular disease, or PVD. But while PVD can apply to any lymphatic or blood vessels and veins, PAD only applies to the arteries.
Many patients do not have any symptoms in the early stages of PAD. But when the peripheral arteries become narrow or occluded, patients may eventually feel bouts of pain, or “leg attacks,” when walking.
PAD affects about 12 million to 15 million people in the U.S. and over 200 million people globally. It usually develops in patients 65 years or older but can be seen as early as age 40 — and even younger in rare cases. The most common causes of PAD include smoking, diabetes and kidney failure.
The same artery blockages that cause PAD make people with the disease four to five times more likely to have a heart attack or stroke. If it progresses to later stages, patients may need limb amputation.
But early detection, diagnosis and intervention can prevent the disease from progressing and help you avoid disability. It may even save your life.
Peripheral Artery Disease Treatment at Rush
If you’ve been diagnosed with PAD, you may feel concerned that your mobility or quality of life will be limited.
Rush offers care that can help you avoid disability and more complicated procedures and surgeries. Treatments for PAD range from help with lifestyle changes to minimally invasive options. We can even offer a second opinion on your prescribed treatment and may find alternatives that better suit your needs.
Our team works across specialties to explore all of your options and create a custom care plan for you. When it comes to management of PAD, our first goal is to help you make lifestyle changes, like quitting smoking, getting more exercise and sticking to a healthy diet. We may explore medications that can also help. These changes can slow or stop the progression of PAD, reduce pain and prevent complications like heart attacks or strokes.
And if you need further treatment, you’ll have access to a heart and vascular care team that regularly ranks among the best in the nation.
Your personalized care plan may include one or more of the following:
- Diet and exercise programs, including rehabilitation when needed.
- Programs to quit smoking.
- Management of other conditions that complicate PAD, like diabetes and kidney disease.
- Medications that can manage pain, prevent or dissolve blood clots and lower blood pressure and cholesterol levels.
- Minimally invasive procedures to restore blood flow if other management has failed or symptoms have advanced in a way that limits quality of life, including the following:
- Balloon angioplasty, a catheter-based procedure to increase blood flow to the legs using balloons such as intravascular lithotripsy (IVL) for heavily calcified arteries.
- Stenting, permanently implanted scaffolds to keep the artery open.
- Atherectomy, a technique for removing atherosclerosis from blood vessels in select cases.
- Bypass surgery or surgery to remove plaque in complex cases to restore blood flow.
Peripheral Artery Disease Diagnosis
Diagnosing PAD in early stages can help you get the treatment you need to preserve your mobility and reduce your risk of complications, like heart attack or stroke. But in the early stages, many patients do not have obvious symptoms.
That’s one reason why people at higher risk for PAD should get regular checkups with their general physician and, when needed, a cardiologist. People at high risk include those who have a family history of PAD, diabetes, a history of smoking and other heart and vascular conditions, like high blood pressure or cholesterol.
If you experience leg pain, which can be an early sign of PAD, you should also see your physician. Leg pain can be a sign of other problems, like arthritis, injuries or normal aging. That’s why it's important to get a diagnosis.
When getting diagnosed for PAD, one of the first tests a cardiologist will do is a pulse check in both legs. A weakened pulse in one or both legs can be a sign of PAD.
The following are a few other tests cardiologists may perform to diagnose PAD:
- Angiogram: This imaging test relies on a dye injected into the veins or arteries that appears on an X-ray. It helps find any narrowing or blockages of the blood vessels.
- Ankle-brachial index: Also called an ABI, this test compares blood pressure in the ankle and arm with a regular pressure cuff and ultrasound.
Stages of Peripheral Artery Disease
PAD is often divided into stages based on symptoms. The stage gets higher as symptoms worsen and the condition becomes more serious.
Generally, PAD stages are classified by the Fontaine system. They are as follows:
- Stage I: There are no outward symptoms yet. There is some artery blockage, but it is not completely blocked.
- Stage IIA: There is mild claudication, which is cramping or pain in the limbs, during or after physical activity.
- Stage IIB: There is moderate to severe claudication during or after physical activity. The limb pain may be felt even after a brief period of movement.
- Stage III: There is ischemic pain while resting, most often in the feet. It may wake the patient during sleep.
- Stage IV: Ulcers may appear, and necrosis or gangrene may set in on the limb.
Peripheral Artery Disease Signs and Symptoms
PAD sometimes does not cause any symptoms or causes only mild symptoms, especially in early stages. But as the condition progresses, many people start to feel pain in the extremities.
But that kind of pain can be a symptom of many other conditions, such as arthritis, anemia, spinal stenosis and nerve damage, or even normal aches from aging.
That is why it’s important to schedule regular checkups with your general physician or cardiologist if you are at high risk.
You should also see a cardiologist if you have any of the following possible symptoms of PAD:
- Claudication, which is cramping, tiredness or heaviness in the arm or leg muscles, especially during activity, that may go away with rest
- Toes and feet that look pale, bluish or discolored
- Leg pain that may wake you up from sleep
- Erectile dysfunction
- Sores or wounds on the toes, feet or legs that heal slowly or not at all
- One leg or foot regularly feeling colder than the other
- Poor nail growth and decreased hair growth over time on the toes or legs
- Gangrene
Women are less likely than men to experience symptoms of PAD in early stages, but they are also more likely to face mobility issues as a complication of the disease. Learn more about PAD in women.
Peripheral Artery Disease Causes
Atherosclerosis is the most common cause of PAD. It happens when plaque buildup causes narrowing in the arteries and blocks the flow of blood. Plaque is made mostly of fat, cholesterol and calcium.
There are some less common causes of PAD as well, including the following:
- Inflammation or swelling of the arteries
- Injury to the arms, legs or blood vessels
- Exposure to radiation
- Muscle or ligament changes
Risks for Peripheral Artery Disease
The following behavior, characteristics and other conditions may increase your risk for PAD:
- Family history of PAD, heart disease or stroke
- Heart and vascular disease
- Hypertension, or high blood pressure
- High cholesterol
- Obesity
- Fibromuscular dysplasia
- Metabolic syndrome
- Stress
- Stroke or “ministroke”
- Diabetes
- Chronic kidney disease
- Preeclampsia
- Smoking
- Sedentary lifestyle
- Age over 50 years old
Black Americans are at higher risk for PAD, and American Indian women are at higher risk than white or Asian American women.
Peripheral Artery Disease Prevention
If any of the risks above apply to you, you may want to talk to your general physician or cardiologist about testing for PAD and taking steps to manage risks.
Some risks, like age or family history, are out of your control. But others are manageable with diet and lifestyle changes. You can reduce your risks for PAD with your physician’s guidance in the following ways:
- Quit smoking, even if you have been smoking for a long time and it seems too late. If you’ve never smoked, do not start.
- Eat a healthy diet with fruits, vegetables and grains. Avoid saturated and trans fats and added sugars.
- Exercise safely.
- Maintain a healthy weight.
- Seek proper treatment and medication for other conditions like diabetes or heart disease that can complicate PAD.
Your care team can help you make these changes safely with diet and exercise programs, programs to quit smoking and monitoring to make sure your blood pressure, cholesterol and blood glucose stay at health levels.
Critical Limb Ischemia/Chronic Limb Threatening Ischemia (CLI/CLTI)
Patients with PAD may present with different symptoms at various stages. At the earliest stage, most patients don't show symptoms. Later they may have calf, thigh or buttock pain when they walk a certain distance that resolves by resting, which is called intermittent claudication.
More advanced PAD patients may present with foot pain at rest or with wounds in the legs or feet that are not healing even with proper wound care, known as critical limb ischemia (CLI) or chronic limb threatening ischemia (CLTI).
Those with diabetic foot ulcers (DFU) make up the largest portion of patients who develop CLI, and the condition is one of the biggest and costliest burdens to the U.S. health care system. Limb loss is the main concern for patients who reach the critical limb ischemia level of PAD.
The diagnosis of CLI also carries a lower survival rate — less than 40% in five years — than many of the cancers known to the public, especially in patients who lose the ability to walk after a major amputation. There are also widespread gender, racial and geographic inequalities in limb loss.
Treatment typically focuses on managing diabetes, making lifestyle changes — exercising, quitting smoking and staying on a healthy diet — along with regular wound care and improving or restoring blood flow when appropriate. With early detection and management, proper wound care and treatment at experienced centers with skilled interventional care specialists can often prevent major and minor amputations.
We routinely offer screenings to our patients coming to cardiology, interventional radiology and vascular surgery clinics. If a screening confirms PAD, the patient will be referred to our dedicated PAD clinic, where testing will be carried out and therapy will be recommended.
Abdominal Aortic Aneurysm (AAA)
The aorta is the main blood vessel that carries blood from the heart to the rest of the body. It is called the "abdominal aorta” while it courses below the diaphragm. The dilation, or ballooning, of this big artery is called abdominal aortic aneurysm (AAA).
Because the aorta is the largest blood vessel in the body, a ruptured abdominal aortic aneurysm causes life-threatening bleeding.
All men 65 or older who are current or former smokers, as well as people with a family history of abdominal aortic aneurysms, are eligible for screening.
Depending on the size of the aneurysm and how fast it is growing, treatment varies from watchful waiting to elective endovascular repair to emergency surgery. At Rush, specialists perform repairs mostly by minimally invasive procedures through tiny incisions.
Rush Excellence in Peripheral Artery Disease Care
- Many care options, all in one place: Rush offers comprehensive care to manage symptoms, keep PAD from worsening and reduce future risk. Your team’s goal is to first rely on helping you with lifestyle changes and medication to avoid invasive procedures. If you do need further care, our interventional vascular specialists provide options that include minimally invasive procedures and surgery to restore normal blood flow.
- Limb preservation expertise: Being told that amputation is your only treatment option can be devastating, and many patients with PAD who are at CLI stages hear it. Aside from having all advanced treatment technologies available, our interventional physicians stand out for their level of training and experience. Having performed thousands of arterial interventions with over 95% success rates in reopening blocked or narrowed arteries, we can provide excellent outcomes to many patients who look for a second or even third opinions to preserve their limbs. Learn more on our Limb Preservation Services page.
- Groundbreaking research and treatments: Specialists at Rush are leaders in research on peripheral artery disease, so they are able to offer patients many new treatments before they are widely available. Our Vascular Interventional Radiology team regularly participates in clinical trials that show great promise, even for patients who've been deemed as having “no option” and are facing major amputation. These trials are paving the way for techniques that give patients the best outcomes without the negative side effects of many current treatments that are widely used.
Peripheral Artery Disease FAQs
Atherosclerosis is the most common cause of PAD, and it is a buildup of plaque, or calcium, in the arteries that causes blockage and does not go away on its own. But medical interventions, like minimally invasive procedures or surgery, can return blood flow to normal and reduce or reverse the effects of peripheral artery disease. Another procedure called atherectomy can remove plaque from the arteries. Medications can also prevent the disease from progressing.
PAD may not be fatal in early stages, but it can lead to complications that are life-threatening. Critical limb ischemia can cause limbs to develop gangrene, which often requires amputation, and infections that can result in death. PAD also indicates a higher risk of heart attack and stroke, which can be fatal.
Peripheral artery disease only refers to diseases of the arteries, while peripheral vascular disease is a term that includes PAD and diseases of veins and other blood vessels. You can learn more about it on our Peripheral Vascular Disease page.
Not necessarily. There are many care options for PAD, especially if it is found early. Lifestyle changes and medications can slow or stop the progression of PAD, and minimally invasive procedures or surgery can restore blood flow in many cases. Rush’s limb preservation services offer many alternatives for treatment.
No, varicose veins are not a sign of PAD, but they can be a sign of another type of peripheral vascular disease called chronic venous insufficiency. This condition can also cause swelling and achiness, and it is serious. If you notice that you have varicose veins, you should see your cardiologist.