- Peripheral artery disease (PAD) is a common circulatory disorder in which arteries that supply blood to the limbs—most often the legs—become narrowed or blocked due to atherosclerosis.
- Atherosclerosis occurs when fatty deposits, cholesterol, calcium, and fibrous tissue build up in the arterial walls, forming plaques that restrict blood flow. As a result, tissues in the affected areas receive insufficient oxygen and nutrients, particularly during physical activity, when demand is higher. PAD is considered a major manifestation of systemic atherosclerotic disease and is strongly associated with an increased risk of heart attack, stroke, and cardiovascular mortality.
- One of the hallmark symptoms of PAD is intermittent claudication, a condition characterized by cramping, pain, or fatigue in the leg muscles that occurs during walking or exercise and is relieved by rest. As the disease progresses, individuals may develop rest pain, non-healing wounds, or ulcers in the feet and toes, indicating severe ischemia. In advanced stages, known as critical limb ischemia, patients face a high risk of tissue loss, gangrene, and possible amputation if left untreated. However, not all individuals with PAD experience symptoms; many remain asymptomatic, leading to underdiagnosis and delayed treatment.
- The major risk factors for PAD mirror those of other atherosclerotic diseases. Smoking is the single most significant modifiable risk factor, greatly accelerating disease progression. Other important contributors include diabetes mellitus, hypertension, hyperlipidemia, obesity, physical inactivity, and advancing age. Genetic predisposition and chronic kidney disease are also recognized as risk enhancers. People with diabetes are at particularly high risk, as the combination of arterial narrowing and peripheral neuropathy increases the likelihood of foot ulcers and infections.
- Diagnosis of PAD typically begins with a physical examination, which may reveal weak or absent pulses in the legs, cool skin, or poor wound healing. The ankle-brachial index (ABI) is a simple and widely used non-invasive test that compares blood pressure in the ankle with blood pressure in the arm to assess arterial blood flow. Imaging studies such as duplex ultrasound, computed tomography angiography (CTA), or magnetic resonance angiography (MRA) may be employed to localize and quantify arterial blockages, particularly in patients being considered for revascularization procedures.
- Management of PAD involves a combination of lifestyle modification, pharmacological therapy, and procedural interventions. Smoking cessation, structured exercise therapy (supervised walking programs), and dietary improvements form the cornerstone of non-invasive treatment. Medications such as antiplatelet agents (aspirin or clopidogrel) reduce the risk of cardiovascular events, while statins and antihypertensives address underlying risk factors. For symptomatic relief, drugs like cilostazol may improve walking distance in patients with intermittent claudication. In more severe cases, revascularization procedures—including angioplasty, stent placement, or surgical bypass—are considered to restore adequate blood flow. Patients with critical limb ischemia may require urgent interventions to prevent amputation.
- PAD is not only a localized problem but also a strong indicator of systemic vascular disease. Patients diagnosed with PAD are at significantly higher risk for coronary artery disease and cerebrovascular disease, making comprehensive cardiovascular risk management essential. Early detection, aggressive risk factor modification, and timely treatment can improve symptoms, preserve limb function, and reduce cardiovascular mortality.
