Peripheral Arterial Disease

Peripheral arterial disease (PAD) is narrowing of the arteries — usually in the legs — because of atherosclerosis (cholesterol plaque build-up). It reduces blood flow, causing leg pain with walking and, if advanced, non-healing wounds or threatened limbs. PAD also signals widespread atherosclerosis, so people with PAD are at much higher risk of heart attack and stroke.

Symptoms

• Cramping or aching in calf, thigh, or buttock muscles when walking (intermittent claudication) — eases with rest
• Weakness or numbness in legs
• Cold or pale foot
• Slow-healing sores or ulcers on toes, feet, or legs
• Shiny, hairless skin on lower legs
• Thick, slow-growing toenails
• Pain in the foot at rest — a warning sign of advanced disease
• Erectile dysfunction — can be an early sign
• Some people have no symptoms

Risk factors

• Smoking — the most important risk factor; PAD is sometimes called a "smoker's disease"
• Diabetes — a major driver in India's large diabetic population
• High blood pressure
• High cholesterol
• Age
• Family history
• Overweight, physical inactivity
• Chronic kidney disease

Diagnosis

• Ankle-brachial index (ABI) — comparing blood pressure at the ankle with the arm; a simple bedside test
• Doppler ultrasound — maps blood flow in leg arteries
• CT or MR angiography, or catheter angiography — for detailed anatomy when intervention is being planned
• Evaluation for coronary and carotid disease, because atherosclerosis is usually widespread

Treatment

• Stop smoking — single most important step
• Supervised exercise (walking to near-pain, rest, repeat) — improves walking distance, often dramatically
• Control blood pressure, cholesterol, and diabetes
• Antiplatelet medicines — to reduce heart attack and stroke risk
• Medicines — for symptom relief
• Angioplasty and stenting — open narrowed arteries through a catheter
• Surgical bypass — in more extensive disease
• Limb salvage procedures — for threatened limb
• Foot care — critical, especially in diabetes

If you have leg pain with walking that eases with rest, or foot wounds that aren't healing — especially if you smoke or have diabetes — see a doctor. Early diagnosis dramatically improves outcomes.