Peripheral Vascular Disease

Peripheral artery disease (PAD) is a progressive disorder that narrows blood vessels beyond the heart and brain — on the periphery, or extremities, of the body — primarily in the pelvis, legs and arms. Persons with PAD commonly experience walking-related leg cramping that subsides with rest. If not treated, severe PAD can result in non-healing ulcers and gangrene.

Peripheral artery disease is a type of vascular disease that affects the arteries beyond the heart. However, the terms peripheral artery disease and peripheral vascular disease are often used interchangeably.

Risk Factors

Because it is a circulatory disease, PAD risk factors are very similar to other diseases of the arteries:

• A personal health history — or family history — of high blood pressure, heart attack, high cholesterol, stroke or diabetes.
• Smoking.
• Obesity: Being more than 25 pounds overweight.
• Eating fried and fatty foods regularly.
• Inactivity: Not exercising moderately at least four times per week.
• Age and gender: Men age 50 and over are more often diagnosed with PAD.

The greatest risk factors for PAD are smoking and diabetes, which reduce blood flow to the arms and legs.

Symptoms

Approximately half of all PAD patients do not experience PAD symptoms, which progress over time, as blood vessels narrow. The most common PAD symptom is claudication — an intermittent aching, cramping or weakness in the legs, buttocks or arms experienced during walking or exercise, yet disappears with rest.

Other PVD symptoms are:

• Limping or abnormal gait.
• Pain in the toes or feet when resting or lying flat at night.
• Leg, foot or arm ulcers, or sores, that are slow to heal or become infected.
• Hair loss on the legs or arms.
• Reddish-purple discoloration of the skin.
• Thickened toenails that lose transparency and sheen.

In severe cases, PAD can result in gangrene, when a body part — particularly the toes and feet — completely loses circulation.

Diagnosis

Diagnosis begins with a medical history and physical examination. Diagnostic procedures may include:

• Angiogram: An X-ray to detect blockage or narrowing of blood vessels. A thin, flexible tube, called a catheter, is inserted into the groin. A contrast dye is injected into arteries and veins; this dye is visible on the X-ray.
• Ankle-brachial index (ABI): A comparison of the blood pressure in the ankle with the blood pressure in the arm.
• Doppler ultrasound: High-frequency sound waves captured by a computer measure blood flow and create images of blood vessels, tissues and organs.
• Magnetic resonance angiography (MRA): A large magnet, radiofrequencies and a computer produce detailed images of organs and structures within the body.

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