From the Guidelines
A leg with Peripheral Artery Disease (PAD) is characterized by reduced blood flow to the lower extremities, resulting in symptoms such as intermittent claudication, atypical leg pain, rest pain, ischemic ulcers, or gangrene, and is often associated with a decrease in overall well-being and quality of life, as well as a markedly increased cardiovascular morbidity and mortality 1. The characteristics of a leg with PAD include:
- Pale or bluish skin color
- Cooler temperature compared to the unaffected leg
- Reduced or absent hair growth
- Weak or absent pulses (e.g., in the dorsalis pedis or posterior tibial arteries)
- Muscle atrophy
- Slow-healing wounds or ulcers
- Thickened toenails Patients with PAD may report intermittent claudication (pain when walking), which improves with rest, and in severe cases, they may experience rest pain, especially at night, as noted in the 2010 performance measures for adults with PAD 1. According to the 2019 scientific statement from the American Heart Association, exercise programs are a crucial component of PAD management, aiming to improve functioning and quality of life, and reduce symptoms such as claudication and functional impairment 1. The diagnosis of PAD is often made using an ankle-brachial index (ABI) ≤ 0.9, which is an independent predictor of increased mortality, and treatment should be directed at improving blood flow, managing risk factors, and preventing progression and potential limb loss 1.
From the Research
Characteristics of a Leg with Peripheral Artery Disease (PAD)
- A leg with PAD is characterized by leg muscle pain, cramping, and fatigue brought on by ambulation/exercise, relieved on rest, and caused by inadequate blood supply 2
- The primary symptom of PAD is intermittent claudication, which is an extremely important marker of atheroma 2
- PAD is a debilitating atherosclerotic disease of the lower limbs and is associated with an increased risk of cardiovascular morbidity and mortality 2
- Symptoms of intermittent claudication include aching pain, numbness, weakness, or fatigue in the muscle groups of the lower extremities, induced by walking or exercise and usually resolve with rest 3
- Disease severity varies from patients who are asymptomatic to those who have unremitting symptoms 3
- A high overlap exists between PAD and coronary artery and cerebrovascular disease, with risks for long-term morbidity and mortality being identical for PAD, intermittent claudication, and coronary artery disease 3
Risk Factors and Associated Conditions
- Risk factors for PAD include advanced age, hypertension, dyslipidemia, diabetes, and cigarette smoking 4
- Approximately 10% to 30% of patients with PAD present with the classic symptom of intermittent claudication, while some patients experience symptoms such as pallor, hair loss, or nonhealing wounds, and up to half of patients are asymptomatic 4
- Patients with PAD also have higher than expected rates of myocardial infarction, stroke, and cardiovascular death 5
Clinical Consequences
- The most common clinical consequences of PAD include pain on walking (claudication), impaired functional capacity, pain at rest, and loss of tissue integrity in the distal limbs that may lead to lower extremity amputation 5
- Despite advances in surgical and endovascular procedures, revascularization procedures may be suboptimal in relieving symptoms, and some patients with PAD cannot be treated because of comorbid conditions 5