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Peripheral artery disease - legs


Definition:

Peripheral artery disease (PAD) is a condition of the blood vessels that supply the legs and feet. It leads to narrowing and hardening of the arteries. This causes decreased blood flow, which can injure nerves and other tissues.

Alternative Names:

Peripheral vascular disease; PVD; PAD; Arteriosclerosis obliterans; Blockage of leg arteries; Claudication; Intermittent claudication; Vaso-occlusive disease of the legs; Arterial insufficiency of the legs; Recurrent leg pain and cramping; Calf pain with exercise

Symptoms:

The main symptoms of PAD are pain, achiness, fatigue, burning, or discomfort in the muscles of your feet, calves, or thighs. These symptoms usually appear during walking or exercise, and go away after several minutes of rest.

  • At first, these symptoms may appear only when you walk uphill, walk faster, or walk for longer distances.
  • Slowly, these symptoms occur more quickly and with less exercise.
  • Your legs or feet may feel numb when you are at rest. The legs also may feel cool to the touch, and the skin may look pale.

When peripheral artery disease becomes severe, you may have:

  • Impotence
  • Pain and cramps at night
  • Pain or tingling in the feet or toes, which can be so severe that even the weight of clothes or bed sheets is painful
  • Pain that is worse when you elevate the legs and improves when you dangle your legs over the side of the bed
  • Skin that looks dark and blue
  • Sores that do not heal
Exams and Tests:

During an exam, the health care provider may find:

  • A whooshing sound when the stethoscope is held over the artery (arterial bruits)
  • Decreased blood pressure in the affected limb
  • Weak or absent pulses in the limb

When PAD is more severe, findings may include:

  • Calf muscles that shrink (wither or atrophy)
  • Hair loss over the legs, feet, and toes
  • Painful, non-bleeding sores on the feet or toes (usually black) that are slow to heal
  • Paleness of the skin or blue color in the toes or foot (cyanosis)
  • Shiny, tight skin
  • Thick toenails

Blood tests may show high cholesterol or diabetes.

Tests for PAD include:

Outlook (Prognosis):

Most cases of peripheral artery disease of the legs can be controlled without surgery. Although surgery provides good symptom relief in severe cases, angioplasty and stenting procedures are being used in place of surgery more and more often.

Possible Complications:

  • Blood clots or emboli that block small arteries
  • Coronary artery disease
  • Impotence
  • Open sores (ischemic ulcers) on the lower legs
  • Tissue death (gangrene)
  • The affected leg or foot may need to be amputated
When to Contact a Medical Professional:

Call your health care provider if you have:

  • A leg or foot that becomes cool to the touch, pale, blue, or numb
  • Chest pain or shortness of breath with leg pain
  • Leg pain that does not go away, even when you are not walking or moving (called rest pain)
  • Legs that are red, hot, or swollen
  • New sores/ulcers
  • Signs of infection (fever, redness, general ill feeling)
  • Symptoms of arteriosclerosis of the extremities
References:

White CJ. Atherosclerotic Peripheral Arterial Disease. In: Goldman L, Schafer AI, eds. Goldman's Cecil Medicine. 24th ed. Philadelphia, PA: Saunders Elsevier; 2011:chap 67.

Mills JL. Lower extremity arterial disease. In: Cronenwett JL, Johnston W, eds. Rutherford's Vascular Surgery. 7th ed. Philadelphia, PA: Saunders Elsevier; 2010:section 15.

Creager MA, Libby P. Peripheral arterial disease. In: Bonow RO, Mann DL, Zipes DP, Libby P, eds. Braunwald's Heart Disease: A Textbook of Cardiovascular Medicine. 9th ed. Philadelphia, PA: Saunders; 2011:chap 61.

Wong PF, Chong LY, Mikhailidis DP, Robless P, Stansby G. Antiplatelet agents for intermittent claudication. Cochrane Database Syst Rev. 2011. Issue 11. Art No.: CD001272. DOI: 10.1002/14651858.CD001272.pub2.

Watson L, Ellis B, Leng GC. Exercise for intermittent claudication. Cochrane Database Syst Rev. 2008. Issue 4. Art No.: CD000990. DOI: 10.1002/14651858.CD000990.pub2.


Review Date: 5/27/2014
Reviewed By: Deepak Sudheendra, MD, Assistant Professor of Interventional Radiology & Surgery, Hospital of the University of Pennsylvania, Philadelphia, PA. Review provided by VeriMed Healthcare Network. Also reviewed by David Zieve, MD, MHA, Isla Ogilvie, PhD, and the A.D.A.M. Editorial team.

The information provided herein should not be used during any medical emergency or for the diagnosis or treatment of any medical condition. A licensed physician should be consulted for diagnosis and treatment of any and all medical conditions. Call 911 for all medical emergencies. Links to other sites are provided for information only -- they do not constitute endorsements of those other sites. Copyright 2002 A.D.A.M., Inc. Any duplication or distribution of the information contained herein is strictly prohibited.

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