Dr Jacob White is an interventional radiologist with over 15 years of experience. He currently serves as Medical Director at USA Vein Clinics, Vascular and Fibroid Centers and is on staff at the Jacobi Medical Centre in NYC. Dr White is a regular contributor to numerous medical journals. 

 

 

Despite being a common condition, few people know the signs of peripheral artery disease (PAD). This disease can sneak up because it is difficult to spot, yet it affects around 6.5 million people aged 40 or older in the United States alone.¹ In some cases, even if they experience classic symptoms, people may not recognize them and attribute them as normal signs of ageing. 

So what is this widespread yet stealthy disease? PAD is a vascular disease caused by plaque building up in the arteries. This is also known as atherosclerosis. PAD can be dangerous because these blockages can restrict circulation to your limbs and organs. Without adequate blood flow, your vital organs, arms, legs and feet can suffer damage. If left untreated, the tissue can become infected or die, a condition called gangrene. PAD is most common in the arteries leading to extremities, particularly the legs and feet. 

The Stages of Peripheral Artery Disease

PAD classification divides the condition into four stages, with stage I being asymptomatic PAD, stage II presenting as symptomatic with intermittent claudication (pain in the legs while exercising), stage III presenting with claudication pain even at rest and stage IV being critical limb ischemia. In other words, ulcers, gangrene and limb death.

It is important to understand the warning signs for PAD, and detect it early to avoid amputations.² There is a lot you can do to keep PAD from getting worse if you catch it in its first or second stages. Once you get into the third and fourth stages, it is harder to treat, but it can still be managed with minimally invasive procedures such as angioplasty and stent placement.

The important thing is to learn the signs and find out if you have any PAD risk factors. That way, you can keep an eye on your vascular health and seek treatment right away if needed. 

The Top Symptoms of Peripheral Artery Disease

One of the most common symptoms of PAD is cramping which occurs during simple activities such as walking up a flight of stairs. The medical term for this symptom is intermittent claudication, and it can also feel like heaviness, numbness, or tingling in the legs while being active.

Someone affected by intermittent claudication may notice that climbing stairs or walking short distances causes this discomfort in the calves, thighs, hips or buttocks. This indicates that the plaque has reached a point where it is narrowing the arteries, restricting blood flow to the leg muscles. Without adequate oxygen from the blood, the muscles cannot keep up with the demands of being active. 

Once the body stops moving, the pain does too. Because the muscles are no longer actively working, the need for oxygenated blood is diminished and the pain subsides.³ Over time and without treatment, intermittent claudication often turns into more severe claudication with leg pain even at rest. 

Other Peripheral Artery Disease Symptoms

Cramping or claudication is not the only PAD symptom, however. A person with PAD may notice that leg hair growth has slowed or stopped in places. Toenail growth may also be affected, with the nails growing slowly due to a lack of oxygen and nutrient–rich blood supply to the tissues. Foot, toe or leg wounds that heal slowly or fail to heal at all are a warning sign of PAD, along with decreased skin temperature and discoloured skin. 

How Long Does it Take Peripheral Artery Disease to Develop?

PAD develops over the course of a lifetime. Plaque can accumulate in the arteries more quickly in some people and more slowly in others, depending on a variety of factors. In some people, heredity predisposes them to PAD.⁴

There are several additional risk factors for this vascular condition, however, including smoking, obesity, high cholesterol, high blood pressure, diabetes, and age: those over age 60 are at increased risk of PAD compared to younger age ranges. However, those with any of the other risk factors for PAD should be screened beginning at age 50.¹ 

In addition to participating in screenings based on age and risk factors, it is important for anyone with PAD symptoms to seek help from a vascular doctor at the first sign of symptoms such as cramping (intermittent claudication) or slow–healing wounds. Once PAD is causing notable symptoms, the atherosclerosis has progressed to the point that it needs prompt treatment to avoid more serious complications.

Diagnosing Peripheral Artery Disease

PAD is diagnosed using a series of tests. A vascular doctor may first do a physical exam to note the presence or absence of ulcers, patchy leg hair or abnormalities in skin temperature or colour. A physician may also order blood tests to help determine whether or not a patient has signs of diabetes, kidney disease or high cholesterol. 

Next, PAD–specific diagnostic tests may be done, including an ankle–brachial index test or an angiogram. During an ankle–brachial index test, the physician measures the blood pressure in a patient’s arm and foot and then compares the two numbers. The resulting score indicates whether or not a patient is likely to have PAD. For an angiogram, or angiography, the vascular doctor uses a catheter, ultrasound imaging and contrast dye to detect blockages within the arteries. 

Your doctor may use one or more of these diagnostic tests to pinpoint how PAD is affecting you. The next step is treatment to help improve blood flow in the affected areas of your vascular system.

Treating Peripheral Artery Disease

While lifestyle changes may help slow the progression of PAD, treatment is often needed to deal with the plaque that has already built up on artery walls. Patients can receive excellent treatment for PAD from board–certified vascular doctors at specialized clinics, such as USA Vascular Centers, which has locations throughout the United States. Vascular doctors can perform three minimally invasive procedures to treat PAD: angioplasty, stent placement and atherectomy. 

Minimally Invasive Peripheral Artery Disease Treatments

An angioplasty involves inserting a balloon–tipped catheter into the vascular system through a small incision in the groin or leg. Once the catheter reaches a blocked area, it inflates, compressing plaque against the artery wall. With a stent placement, the vascular doctor performs the angioplasty but adds a small mesh stent into the artery to keep it propped open. During an atherectomy, the vascular doctor uses a blade or laser to remove the plaque from the artery entirely and collect it in a vessel to safely remove it from the body. 

Signs and symptoms of PAD may become less severe following one of these treatments.

It is important that regardless of the treatment, patients with PAD follow the physician’s instructions for post–treatment care, including making appropriate lifestyle changes, such as quitting smoking and taking any prescribed medications. 

Are You at Risk for Peripheral Artery Disease?

PAD is prevalent, but by knowing the symptoms, people can spot signs of PAD and seek medical care before the disease progresses to its most damaging stages. Do you want to find out if you could be at risk for PAD? Take a quiz to determine your PAD risk.

References:

1.  Centers for Disease Control and Prevention. Peripheral Arterial Disease (PAD). , 2021. Available at: www.cdc.gov/heartdisease/PAD.htm (accessed 12 May 2022). 
2. Modern Vascular. Revascularization or Amputation? DATE? Available at: https://modernvascular.com/revascularization-vs-amputation/ (accessed 12 May 2022).
3.   American Heart Association. Symptoms and Diagnosis of PAD. 2021. Available at: www.heart.org/en/health-topics/peripheral-artery-disease/symptoms-and-diagnosis-of-pad (accessed 12 May 2022).
4.  Veterans Affairs: VA.gov. Study Finds New Genetic Markers for Peripheral Artery Disease. 2019. Available at: www.research.va.gov/currents/0719-Study-finds-new-genetic-markers-for-peripheral-artery-disease.cfm (accessed April 20, 2022). 

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Acknowledgements: Writing assistance of this article was supported Ignite Visibility, and reviewed by USA Vascular Centers.

Disclosures: Jacob White has no financial or non-financial relationships or activities to declare in relation to this article. 

Compliance with ethics: This article is an opinion piece and does not report on new clinical data, or any studies with human or animal subjects performed by any of the authors.

Data availability: Data sharing is not applicable to this article as no datasets were generated or analysed during the current study/during the writing of this article.

Access: This article is freely accessible at touchCARDIO.com © Touch Medical Media 2022

Corresponding author: Jacob White, USA Vein Clinics, Vascular and Fibroid Centers, USA.

Support: Writing of this article was supported by Touch Medical Media.