Peripheral Artery Disease (PAD)

What Is Peripheral Artery Disease (PAD)?

Peripheral artery disease (PAD) occurs when the arteries that carry blood to your legs, abdomen and arms become narrowed, reducing blood flow. The narrowing occurs when plaque, a fatty substance, builds up inside these arteries.

Many people with peripheral artery disease (also called peripheral arterial disease or peripheral vascular disease) have discomfort or pain when walking, called claudication. The reduced blood flow may damage skin, muscle and other tissues. In severe cases, blood clots or other problems can block arteries completely and even cause limb loss. Treatment can prevent these outcomes.

Peripheral Artery Disease Causes

Peripheral artery disease results when you have atherosclerosis or hardening of the arteries due to plaque buildup. Risk factors for peripheral artery disease include:

Diabetes mellitus
High blood pressure or high cholesterol
Inactive lifestyle
Kidney failure
Male sex
Obesity
Smoking
Family history of vascular problems

What Are Typical Symptoms of Peripheral Artery Disease?

Early peripheral artery disease symptoms are often mild. But if you have symptoms, you should see a Penn Medicine physician, especially if you have risk factors for peripheral artery disease. Left untreated, peripheral artery disease can lead to increasing discomfort and serious health problems.

Symptoms of peripheral artery disease include:

Calf, hip or thigh cramp after walking, climbing stairs or exercising
Erectile dysfunction, especially if you have diabetes
Reduced toenail growth or hair growth on your legs
Sensation of cold in your foot or lower leg
Skin color change on your legs
Sores that are slow to heal on your legs, feet or toes
Weak or numb leg

How Is Peripheral Artery Disease Diagnosed?

The first step in diagnosing peripheral artery disease is a physical exam. We'll talk with you about your symptoms and your lifestyle. We may also order blood tests to check your cholesterol, triglycerides and blood sugar.

Your doctor may order imaging tests to understand the blood flow to your extremities. You may have testing in your doctor's office or in our renowned vascular testing and diagnosis labs. Your testing may include:

Ankle-brachial index: Compares the blood pressure in your arms and legs
CT angiography (CTA): Provides detailed cross-section images of arteries, using a contrast material (dye) and a series of X-rays
Duplex ultrasound: Shows the artery in imaging created by sound waves and measures blood flow to reveal a potential blockage
MR angiography (MRA): Uses a strong magnetic field instead of X-rays to show clear cross-sections of your arteries
Peripheral angiogram: Minimally invasive test provides doctors a direct view of blockages using a camera mounted on a catheter (long, narrow tube inserted into the artery)

Peripheral Artery Disease Treatment at Penn Medicine

The goal of peripheral artery disease treatment is to reopen clogged or blocked arteries to restore blood flow. Penn Medicine provides nonsurgical, minimally invasive and surgical treatments for peripheral artery disease.

Nonsurgical Care

Making lifestyle changes can make a big difference in the symptoms and progression of peripheral artery disease. Your doctor may recommend:

Improve your diet: Aim for a diet low in salt, sugar and processed foods and rich in vegetables, whole grains, nuts and seeds, fish and poultry instead of red meat, and low-fat dairy.
Manage diabetes: If you have diabetes, it's important to control your blood sugar. Talk with your health team about the best steps to take.
Stay or become active: Activity can be challenging with peripheral artery disease, because walking can be painful. Your doctor may recommend a rehabilitation program that can help you more comfortably increase your activity.
Stop smoking: You can stop smoking with help from our compassionate, effective program, Penn Stop.

Medications

Your doctor may prescribe medication for peripheral artery disease. These medications can reduce your chance of developing complications from PAD. They can also reduce your risk of other problems, such as heart attack and stroke.

Your doctor may prescribe medicine to:

Prevent blood clots: Medications such as aspirin, clopidogrel (Plavix), dabigatran (Pradaxa) or warfarin (Coumadin) reduce the risk of clots.
Lower cholesterol: Statins and other drugs can reduce blood cholesterol levels.
Reduce high blood pressure: Drugs such as angiotensin-converting enzyme (ACE) inhibitors or angiotensin-receptor blockers can lower blood pressure
Improve your walking distance: A medication called cilostazol can help improve walking distance if you have claudication.

Procedures and Surgeries

For some people, medicine and lifestyle changes don't resolve symptoms of peripheral artery disease. Penn Medicine vascular surgeons, interventional cardiologists and interventional radiologists have expertise in procedures to treat PAD. We offer advanced minimally invasive (endovascular) and surgical procedures including:

Angioplasty and stent placement: A physician inserts a catheter through a tiny incision and threads a miniature balloon to the blockage. Inflating the balloon presses the artery open. We may place one or more stents (small mesh tubes) to hold the artery open. Sometimes, we use drug-eluting balloons or stents. These devices release medicine to help keep the artery open.
Atherectomy: In a procedure similar to angioplasty and stenting, the physician inserts a catheter to the point of a blockage. The catheter has a tiny cutting blade that the surgeon uses to carefully cut away plaque to reopen the artery.
Lithoplasty: This innovative technique uses a shock wave to break down calcified plaque in the arteries. Surgeons can then treat the blockage with balloons or stents, reopening the artery.
Bypass surgery: If part of an artery is completely blocked, a surgeon can perform bypass surgery. The surgeon uses a vein from another part of your body, or an artificial vein, to graft (attach) above and below the blockage to reroute blood flow. Learn more about femoral popliteal bypass surgery.

Limb Preservation Care for PAD at Penn Medicine

In severe cases, peripheral artery disease can lead to critical limb ischemia (lack of blood flow to your lower leg or foot). This condition can cause nonhealing wounds that can lead to tissue death (gangrene). Our teams work to prevent amputation and limb loss through Penn Medicine Advanced Limb Preservation.