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What is Peripheral Arterial Disease or P.A.D.?

Peripheral Arterial Disease, or P.A.D. as it is often shortened, occurs when the arteries in the legs become narrowed or clogged with fatty deposits, otherwise known as plaque. The build-up of plaque causes the arteries to harden and narrow, a process called atherosclerosis. Atherosclerosis in the leg arteries reduces blood flow to the legs and feet, resulting in poor circulation.

P.A.D. occurs most often in the arteries in the legs, but it also can affect other arteries that carry blood outside the heart. This includes arteries that go to the aorta, the brain, the arms, the kidneys and the stomach. When arteries inside the heart are hardened or narrowed, it is called coronary artery disease or cardiovascular disease.

Like other diseases related to the heart, P.A.D. can be improved with lifestyle changes, medications, or, if needed, endovascular or surgical procedures.

The Impact of P.A.D.

Lower-extremity P.A.D. affects about 8 million Americans. The presence of hardened arteries in the legs makes it more likely these people will have hardened and narrowed arteries leading to the heart and the brain. People with P.A.D. are at high risk for having a heart attack or a stroke.

When blood flow to the legs is severely reduced, people with P.A.D. may experience pain when walking. P.A.D. also can cause other complications that can lead to amputation.



Benefits of Walking with P.A.D.

Walking can greatly improve the quality of life for people with peripheral arterial disease (P.A.D.). Research shows that a formal walking program can effectively reduce leg pain or cramps (claudication). Over time, walking may be a more effective treatment than medication or surgery for reducing leg pain.

For people with P.A.D., a regular walking program will:

  • Help you stay active.
  • Help control blood glucose, blood presure, cholesterol, and body weight.
  • Lower your chances of having a heart attack or stroke



Diabetes and P.A.D.

People with diabetes are at higher risk for P.A.D. It is estimated that one out of three people with diabetes over age 50 has P.A.D. African-Americans and Hispanics who have diabetes are at even higher risk for P.A.D.

People with both diseases are much more likely to have a heart attack or stroke than those who just have P.A.D., and they are more likely to die at a younger age.

Because diabetes can decrease feeling or sensation in the feet or legs, many people also may have P.A.D. but not know it. Or they may have P.A.D. that goes undiagnosed. In addition, when blood flow to your feet and legs is narrowed or blocked due to P.A.D., cuts or wounds are more difficult to heal, increasing the potential risk for amputation.



Warning signs of P.A.D.:

  • Fatigue, tiredness or pain in the legs, thighs or buttocks that always happens with walking but that goes away with rest.
  • Foot or toe pain at rest that often disturbs your sleep.
  • Skin sores or wounds on your feet or toes that are slow to heal.



Smoking and P.A.D.

In addition to being a major cause of heart disease, cancer and lung disease, smoking also is the number- one cause of P.A.D. Smoking even half a pack of cigarettes per day may increase the risk of P.A.D. by 30 to 50 percent.

Smoking speeds the build-up of plaque in the artery walls and increases the formation of leg artery blockages. Smoking constricts blood vessels and causes the blood to clot.

As a result, smoking causes P.A.D. to get worse faster. P.A.D. increases the chance of having leg pain or cramping even while at rest, losing a foot or a leg due to amputation, or having a heart attack or stroke. As many as one out of two people with P.A.D. who continue to smoke will have a heart attack or stroke or die within five years.



Reasons to Quit Smoking

If you have P.A.D, quitting smoking may save your life. Quitting smoking can lower the risk of heart attack, stroke or death. In addition:

  • Your blood pressure will be lower in just a few days.
  • If you have diabetes, the risk of foot ulcers, eye problems, nerve damage and kidney disease will be reduced.
  • You will lower your risk of cancer of the mouth, throat, lungs and bladder.
  • Within one year of quitting, your blood flow and breathing will be improved and your coughing and shortness of breath will be reduced.



High Blood Pressure and P.A.D.

High blood pressure not only increases the risk of heart attack, stroke, eye problems and kidney disease, but also the risk of P.A.D. Over time, high blood pressure makes blood vessel walls rougher and thicker. There also is a greater build-up of plaque, which causes arteries to harden and narrow, which in turn makes it harder for blood to flow through the vessels.

Controlling your blood pressure is an important part of controlling or preventing P.A.D. Have your blood pressure checked at least two to four times a year and take action to keep your blood pressure in control.



Cholesterol and P.A.D.

Too much cholesterol in your blood causes the walls of blood vessels to become narrowed or clogged with fatty deposits called plaque. Plaque builds up and causes hardening and narrowing of the arteries (atherosclerosis), which slows or blocks blood flow.

P.A.D. occurs when the arteries in the legs are hardened and clogged. When arteries harden in one part of the body, it is likely they have hardened in other parts, such as the heart and brain. Therefore people with P.A.D are at much higher risk for a heart attack or stroke. Studies show that controlling cholesterol levels can help people with P.A.D. lower their chances of a heart attack or stroke.



The Link Between Blood Clots and P.A.D.

People with P.A.D. are at high risk for a heart attack or stroke because of the build-up of plaque in their blood vessels. If a piece of plaque breaks off, red blood cells (platelets) clump together inside the blood vessel to form a clot on top of the plaque. This clot can limit or even block the flow of blood to your heart or brain, causing chest pain, a heart attack or stroke. Medications are available that can help prevent blood clots from forming, reducing the risk of heart attack or stroke.



Special Treatments for P.A.D.

Most people with P.A.D. do not have any symptoms. People with diabetes over the age of 50 should be tested for P.A.D. Testing is also recommended for people with diabetes under the age of 50 who have other risk factors, such as smoking, high blood pressure or cholesterol problems.

Like other cardiovascular diseases, P.A.D. can be treated by lifestyle changes and medications that lower the risk heart attack or stroke.

These lifestyle changes include:

  • quitting smoking
  • taking medications to control blood pressure, cholesterol and blood glucose (if you have diabetes)
  • taking anti-platelet medications such as aspirin
  • getting regular physical activity such as walking for 30 minutes at least 3 or 4 times per week
  • following a heart-healthy diet that includes lots of fruits, vegetables and low-fat dairy products and that is moderate in total fat and low in saturated fat and cholesterol.
  • seeking a special P.A.D. exercise program if you have pain or cramps in your legs


For most people with P.A.D., these tips may be enough to control the disease and even improve symptoms. When leg arteries are severely clogged or narrowed, endovascular procedures or bypass surgery may be needed to improve blood flow to the legs and feet.



Foot Care and P.A.D.

Because of reduced blood flow, people with P.A.D. are more likely to have foot problems. Minor problems such as cuts, sores or blisters may not heal quickly or heal at all.

Diabetes further increases the risk of people with P.A.D. for foot problems. In addition to poor circulation to their feet and legs, they also may have nerve damage from high blood glucose levels. This nerve damage (or diabetic neuropathy) can cause loss of sensation in the feet. A person may not feel a small rock inside his or her sock that is causing a sore or a blister caused by poorly fitting shoes.

For people with P.A.D. and diabetes, minor foot injuries can turn into serious infections. If these sores are not treated right away, they may lead to amputation of a toe, foot or leg. With P.A.D, you can prevent serious foot problems by taking care of your feet every day.


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