A Visual Guide to PAD

PAD stands for peripheral artery disease. It’s when arteries that carry blood from your heart to distant parts of your body become narrow because of a buildup of plaque inside the vessels. This can slow down blood flow to your limbs. PAD most commonly affects your legs. 

The most common symptom is leg pain or cramps when you walk. This is called claudication. Your legs may feel heavy, numb, weak, or tired.  The pain usually eases once you rest. You may have no symptoms, or very mild ones, until your arteries are more than halfway narrowed by plaque.

As the condition gets worse, you may feel burning or pain in your feet even at rest. The skin on your feet may feel cool, look shiny, or change colors. Your leg hair may stop growing. You may develop sores on your feet or toes that don’t heal. Men with PAD may develop erectile dysfunction (ED).

Leg cramps or tired, heavy legs are easy to mistake for other conditions. You and even your doctor may think your pain is arthritis, general muscle aches, or just part of getting older. PAD is often overlooked and undiagnosed until your symptoms worsen.

The most common cause is atherosclerosis -- a buildup of fat inside arteries. Fatty deposits can turn into plaque that narrows your arteries. This makes it hard for blood to flow to your lower body. Blood vessel inflammation, limb injuries, or radiation exposure are less common causes of PAD.

Some things you can manage put you at higher risk of developing PAD. These include smoking, being obese, high blood pressure, high cholesterol, and diabetes. Other risk factors are out of your control. They include being older than 60, kidney disease, having a family history of heart disease, and having high levels of the amino acid. Also, African Americans have double the risk of PAD compared to people of other races.

Left untreated, PAD can become severe. A foot sore could turn into gangrene and cause you to lose your foot or leg. If you have PAD, you’re likely to have plaque build-up in other arteries too. This increases your risk of heart attack, stroke, transient ischemic attack (TIA or mini-stroke) or kidney problems.

A diagnosis starts with a physical exam, blood tests, and review of your symptoms, such as walking pain or poorly healing foot sores. Your doctor can feel for a weaker pulse in your leg arteries compared to your arms. Ultrasound scans can find narrowed or blocked arteries in your lower limbs.

An ankle-brachial index (ABI) uses a cuff to compare blood pressure in your leg and arm. Angiography is a more invasive test where dye is injected into your arteries through a catheter tube. Doctors then use special X-rays or CT scans to scan and track your blood flow.

Some treatments can help keep PAD from getting worse. Your doctor may prescribe medication to lower cholesterol or blood pressure, or manage blood sugar if you have diabetes. To prevent blood clots and improve blood flow, they may prescribe daily aspirin  or clopidogrel (Plavix).

Your doctor may prescribe cilostazol (Pletal) or pentoxifylline (Pentoxil), medications that ease the on-and-off leg pain caused by PAD. These drugs widen narrowed vessels to ease blood flow, so you can do more activities.

If medications don’t help, your doctor may recommend surgery to treat PAD pain. Angioplasty is insertion of a tiny balloon that’s inflated to widen arteries. A tube called a stent can also be placed to hold open these vessels. Bypass surgery reroutes blood flow around blocked arteries. Your doctor can also remove blockages or inject a drug to dissolve blood clots.

Healthy lifestyle habits help you manage PAD. Don’t smoke, manage your weight, maintain an exercise routine, and eat a low-fat diet with lots of fruits and veggies. To prevent sores, you’ll need to take extra care of your feet to make sure they are clean and dry. You’ll also need to avoid over-the-counter cold medicines with pseudoephedrine, which constricts already-narrow arteries.

Many risk factors for PAD are things you can control. If you smoke, you should try to quit, take off any extra pounds, and if you have high cholesterol, diabetes, or high blood pressure, make sure you stick with your treatment plans for those conditions.  Exercise is important. Work with your doctor to come up with an exercise plan that’s right for you.