What is Peripheral Arterial Disease?

Atherosclerosis (literally, “hard arteries”) is perhaps the most prevalent disease process in Americans over the age of 50. In this condition plaques, which are generally composed on a mixture of cholesterol and blood cells, build up along the walls of arteries and may eventually reduce the diameter of an artery to the point of restricting blood flow (a narrowing of an artery is called a stenosis). When atherosclerosis limits the flow of blood into the lower extremities a condition called peripheral arterial disease (PAD) is said to be present.

What are the Symptoms of PAD?

The “classical” or “textbook” symptom of PAD is pain in the lower extremities and/or buttocks that occurs while walking that is then relieved by resting. This particular type of pain is known as intermittent claudication. It is well-known that the time required for intermittent claudication to occur is an indication of the severity of PAD. For example, if pain occurs after walking a short distance (less than 2 city blocks) the extent of the patient’s PAD is assumed to be more severe than if similar pain occurred only after walking for 6 blocks.

Other signs of PAD that a health care provider might find in PAD include decreased to absent pulses in the groin or legs, a poorly-healing sore or injury (particularly on the feet), toenails that are thickened and discolored, and an absence of hair on the calves or feet.

Some medical conditions (and risk factors) are associated with PAD. These conditions include:

• Smoking (perhaps the most significant risk factor)
• Male sex (much higher incidence of PAD in men)
• A family history of circulatory conditions
• Diabetes (Insulin-dependent diabetics will often have circulation problems)
• Hypertension
• Elevated lipoprotein (cholesterol) levels in the blood (hyperlipidemia), particularly if there are elevated levels of low-density lipoproteins (the so-called “bad cholesterol”)