Peripheral Artery Disease

What Is Peripheral Artery Disease? 

Peripheral artery disease (PAD) occurs when a fatty substance (plaque) builds up in your peripheral arteries. Your peripheral arteries include all the arteries outside your heart. PAD can affect any of the peripheral arteries throughout your body, but it’s most common in the legs. 

Your peripheral arteries deliver oxygen-rich blood to your body. In PAD, plaque buildup narrows your arteries and blocks blood flow. 

Many people with peripheral artery disease don’t experience any symptoms. If you do have PAD symptoms, they usually affect your legs. You may have leg pain, aching or heaviness after physical activity (claudication). This discomfort usually goes away when you stop physical activity. 

Other symptoms of PAD may include: 

• Coldness in one foot or leg
• Paleness or discoloration in your legs or feet
• Tingling in your legs or feet 

As PAD worsens, you may develop wounds or ulcers (open sores) that don’t heal. In severe cases, you may lose a toe, foot or leg as a result of PAD. 

With appropriate treatment, these complications are rare. If you have a nonhealing wound on your legs or feet, you should see a vascular surgeon for evaluation. Early treatment can lower your risk of further complications such as limb loss. 

Peripheral artery disease develops because of plaque buildup called atherosclerosis. Several factors increase your risk of atherosclerosis, including: 

• Age: Most people with PAD are 65 or older.
• Family history: Your risk increases if you have a family history of PAD or other blood vessel (vascular) diseases.
• Health conditions: Diabetes, high blood pressure, high cholesterol and obesity can all increase your risk of blood vessel problems.
• Health habits: Not exercising and eating a poor diet increase your risk of atherosclerosis.
• Smoking: Smoking is one of the most significant, preventable risk factors for PAD. It increases blood pressure, damages blood vessels and decreases blood flow. 

PAD diagnosis starts with a conversation about your symptoms. Your doctor ranks your symptoms on a scale of one to six. One means you have no symptoms, while six means you have a high risk of limb loss. The doctor uses this scale to determine which tests or treatments you might need. 

Your doctor physically examines you, checking the strength of the pulses in your legs. Then, they may use tests such as: 

• Ankle-brachial index: You wear a blood pressure cuff on your upper arm and ankle. Your doctor uses an ultrasound wand to view your arteries while taking your blood pressure. They calculate the ankle-brachial index, the ratio of your blood pressure in your ankle compared to the pressure in your arm. A ratio below 0.9 may point to PAD.
• Duplex ultrasound: Your doctor uses sound waves to look at your blood vessels. A duplex ultrasound examines your blood vessel structure, the rate of blood flow and whether you have blockages.

Depending on your test results, you may get a CT scan to check for problems in your aorta, the largest artery in your body. It starts at the top of your heart and runs through the chest to the abdomen. Peripheral arteries branch off the aorta to carry blood away from your heart. 

You may also get a diagnostic angiogram. During an angiogram, your doctor inserts a small, flexible tube (catheter) through one of your blood vessels. This test enables us to look at blood vessel blockages more closely. Usually, you only need an angiogram if your doctor believes you’ll need a procedure to treat PAD. 

PAD treatment depends on the severity of your symptoms and the risk of complications. You and your doctor work together to create a personalized, effective care plan. Treatment may include: 

Nonsurgical PAD treatment 

You may benefit from nonsurgical treatments if you have one or more mild blockages (a rank of two or three on the diagnostic scale). You can often manage symptoms or prevent further blockages with lifestyle changes, such as: 

• Eating a nutritious, low-sodium diet
• Exercising more frequently
• Losing weight, if needed
• Quitting smoking 

Your doctor may also prescribe medications to decrease your risk of complications. These medicines may lower your cholesterol or blood pressure or reduce your risk of blood clots. 

Catheter-based procedures 

Your vascular surgeon may recommend a minimally invasive procedure to remove plaque and restore blood flow. These techniques use a small, flexible tube (catheter) inserted through your blood vessels. They include: 

• Angioplasty: Your vascular surgeon places a deflated balloon through the catheter and directs it to the affected artery. The balloon is inflated to move plaque out of the way.
• Stent placement: Your surgeon places a small metal tube (stent) to keep the artery open. The stent may be coated with a medication that prevents the artery from re-narrowing. Stents are often used along with angioplasty.
• Atherectomy: Your surgeon uses a device, laser or blade to scrape away or dissolve plaque.

Your doctor may use one or all of these techniques during a catheter-based procedure. They tailor the approach to your needs so you get the best results. 

Peripheral artery bypass surgery 

Your doctor may recommend bypass surgery if you’re not a good candidate for a catheter-based procedure. Surgery may also be appropriate if you had a catheter-based procedure that wasn’t successful. 

Peripheral artery bypass surgery is an open procedure. Your vascular surgeon takes another vein from your leg or uses artificial tubing. They create a new path for blood to flow around the blocked artery. 

UCLA Health leads one of the country’s highest-volume centers for peripheral artery disease. We have pioneered minimally invasive treatments and continue to research and advance the field. You receive care from physician-scientists who study best practices and provide the latest treatment options.