What is PAD?
Peripheral arterial disease (PAD) is the narrowing or blockage of the arteries that carry blood to the limbs, usually the legs. It is caused mainly by atherosclerosis (the build-up of fatty plaques in the artery wall).
It increases the risk of heart attack and stroke, and is an important marker of cardiovascular disease.
Symptoms
- Intermittent claudication: pain in the legs when walking that eases with rest
- Cold or tingling feet
- Night cramps in the legs
- Shiny, hairless skin on the affected leg
- Thick, brittle toenails
- Wounds on the feet that do not heal
- In severe cases: pain at rest and gangrene
Risk factors
- Smoking (the main factor)
- Diabetes mellitus
- High blood pressure
- High cholesterol
- Obesity
- Physical inactivity
- Age over 50
- Family history
Diagnosis
- Ankle-brachial index (ABI): comparison of the blood pressure at the ankle and in the arm
- Doppler ultrasound: identifies obstructions and assesses blood flow
- CT or MR angiography: detailed mapping of the arteries
- Conventional angiography: for surgical planning
Treatment
- Risk-factor control: stop smoking, control diabetes, blood pressure and cholesterol
- Supervised exercise: improves circulation
- Medication: antiplatelet agents (aspirin, clopidogrel), vasodilators, statins
- Angioplasty: unblocking with a balloon catheter and/or stent
- Revascularisation surgery: bypass or thromboendarterectomy
5 surprising facts about PAD
- 1 in 5 people over 65 has PAD
- Most cases are ASYMPTOMATIC in the beginning
- Smoking is the main modifiable factor
- People with PAD have 4–5 times more risk of heart attack
- Supervised exercise is the most effective treatment (together with stopping smoking)
Read more about the examination that maps the arteries in Doppler ultrasound.