What are the symptoms of Peripheral Artery Disease (PAD)?

From the Guidelines

Peripheral Artery Disease (PAD) symptoms include leg pain or cramping during activity, numbness or weakness in the legs, and coldness in the lower leg or foot, and can be asymptomatic in some patients. According to the 2024 ACC/AHA/AACVPR/APMA/ABC/SCAI/SVM/SVN/SVS/SIR/VESS guideline for the management of lower extremity peripheral artery disease 1, PAD is a common cardiovascular disease associated with increased risk of amputation, myocardial infarction, stroke, and death, as well as impaired quality of life (QOL), walking performance, and functional status. The guideline defines 4 clinical subsets of PAD: asymptomatic PAD, chronic symptomatic PAD (including claudication), chronic limb-threatening ischemia, and acute limb ischemia.

Some key symptoms of PAD include:

• Intermittent claudication, which feels like a cramping pain in the calves, thighs, or buttocks that occurs during walking and improves with rest
• Rest pain (pain even when not active), especially at night
• Critical limb ischemia with tissue damage
• Numbness or weakness in the legs
• Coldness in the lower leg or foot
• Sores on toes, feet, or legs that won't heal
• A change in leg color
• Hair loss or slower hair growth on feet and legs
• Slower toenail growth
• Shiny skin on the legs
• No pulse or a weak pulse in legs or feet
• Erectile dysfunction in men

The 2016 AHA/ACC guideline on the management of patients with lower extremity peripheral artery disease 1 also provides a detailed definition of PAD key terms, including claudication, acute limb ischemia, and critical limb ischemia. The 2024 lower extremity peripheral artery disease guideline-at-a-glance 1 emphasizes the importance of detecting PAD through history, physical examination, and resting ankle-brachial index, and prescribing effective medical therapies to prevent major adverse cardiovascular events and major adverse limb events.

It is essential to seek medical attention if you experience any of these symptoms, as PAD increases the risk for heart attack and stroke. Regular screening is also crucial for those with risk factors, such as smoking, diabetes, high blood pressure, high cholesterol, advancing age, and family history.

From the Research

PAD Symptoms

• The most common presenting symptom of Peripheral Artery Disease (PAD) is claudication, however, only 10% of patients have classic claudication 2.
• Patients with PAD often have reduced walking capacity and are at risk of acute and chronic critical limb ischemia leading to major adverse limb events, such as peripheral revascularization or amputation 3.
• PAD symptoms can be managed with exercise, smoking cessation, statin therapy, and antiplatelet therapy with aspirin or clopidogrel, and possibly cilostazol in patients with no history of heart failure 2.

Diagnosis and Screening

• The ankle-brachial index (ABI) can be used to screen for and diagnose PAD in the primary care setting, with an ABI of less than 0.9 associated with a two- to fourfold increase in relative risk for cardiovascular events and all-cause mortality 2.
• The American Diabetes Association recommends ABI screening for patients older than 50 years who have diabetes mellitus, and the American Heart Association recommends screening all patients 65 years and older and those 50 years and older who have a history of diabetes or smoking 2.
• However, the U.S. Preventive Services Task Force recommends against screening for PAD, as there is no evidence that screening leads to fewer cardiovascular events or lower all-cause mortality 2.

Treatment Options

• Medical therapies have demonstrated efficacy in reducing the risk of major adverse cardiovascular events and major adverse limb events, and improving function in patients with PAD by modulating key disease determining pathways including inflammation, vascular dysfunction, and metabolic disturbances 3.
• Treatment with guideline-recommended therapies, including smoking cessation, lipid lowering drugs, optimal glucose control, and antithrombotic medications lowers the incidence of major adverse cardiovascular events and major adverse limb events 3, 4.
• Clopidogrel monotherapy is guideline-recommended in symptomatic PAD, and has been shown to significantly reduce the risk of major adverse cardiovascular events compared with aspirin, without increasing bleeding risk 5.