Understanding Peripheral Artery Disease (PAD)
Peripheral Artery Disease (PAD) is a condition where arteries outside the heart become narrowed or blocked due to atherosclerosis (buildup of fatty deposits), reducing blood flow to the limbs, most commonly the legs. 1
What Causes PAD?
PAD develops when plaque builds up in the arteries that supply blood to your limbs. This process:
- Results from atherosclerosis - the same disease process that causes coronary artery disease
- Progressively narrows and hardens the arteries
- Reduces blood flow to muscles and tissues
- Can eventually lead to tissue damage or death if severe enough
Who Gets PAD?
PAD affects approximately 8-12 million Americans 1, with prevalence rates of:
- 12% of the general adult population
- Nearly 20% of adults over age 70
- 29% of people who are:
- Age 70 or older
- Age 50-69 with at least a 10-pack-per-year smoking history
- Age 50-69 with diabetes 1
Common Symptoms
PAD can present in various ways:
- Asymptomatic - Up to 50% of patients have no symptoms 1
- Intermittent claudication - The most typical symptom, characterized by:
- Fatigue, cramping, or pain in leg muscles during walking
- Relief of symptoms with rest (usually within 10 minutes)
- Atypical leg pain - Discomfort that doesn't follow the classic claudication pattern
- Critical limb ischemia - More severe manifestations including:
- Rest pain (especially at night)
- Non-healing wounds or ulcers
- Gangrene in severe cases
How PAD Is Diagnosed
The most common diagnostic tests include:
Ankle-Brachial Index (ABI) - A simple, non-invasive test comparing blood pressure in the ankle to blood pressure in the arm
- ABI ≤0.9 indicates PAD
- ABI 0.91-0.99 is borderline
- ABI 1.0-1.4 is normal
- ABI >1.4 suggests non-compressible vessels 2
Pulse examination - Checking for diminished or absent pulses in the legs and feet
Duplex ultrasound - First-line imaging to confirm and characterize PAD lesions 2
Why PAD Matters
PAD is not just a leg problem - it's a marker of systemic atherosclerosis:
- Indicates increased risk for heart attack and stroke
- Associated with 3-fold higher risk of cardiovascular events and death 2
- Often coexists with coronary artery disease and cerebrovascular disease
Common Pitfalls in PAD Recognition
- Underdiagnosis - More than 70% of primary care providers are unaware of PAD in affected patients 1, 2
- Symptom variability - Only about one-third of PAD patients have classic claudication symptoms 1
- Confusing PAD with other conditions - Conditions like spinal stenosis, arthritis, or venous disease can mimic PAD symptoms 2
- Overlooking asymptomatic disease - Many patients have significant disease without symptoms
Treatment Approaches
Treatment focuses on reducing cardiovascular risk and improving leg symptoms:
Lifestyle modifications:
- Smoking cessation - critical for slowing disease progression
- Regular exercise - structured programs improve walking distance
- Healthy diet and weight management
Medications:
- Antiplatelet therapy (aspirin or clopidogrel)
- Statins to lower cholesterol
- Blood pressure management
- Cilostazol for claudication symptoms (if no heart failure)
Revascularization (for severe disease):
- Endovascular procedures (angioplasty, stenting)
- Surgical bypass for suitable candidates
PAD is a serious but treatable condition that serves as an important warning sign for overall cardiovascular health. Early diagnosis and comprehensive treatment can improve quality of life and reduce the risk of heart attack, stroke, and limb loss.