Peripheral vascular disease; PVD; PAD; Arteriosclerosis obliterans; Blockage of leg arteries; Claudication; Intermittent claudication; Vaso-occlusive disease of the legs; Arterial insufficiency of the legs; Recurrent leg pain and cramping; Calf pain with exercise
Peripheral artery disease (PAD) is a condition of the blood vessels that supply the legs and feet. It occurs due to narrowing of the arteries in the legs. This causes decreased blood flow, which can injure nerves and other tissues.
PAD is caused by atherosclerosis. This problem occurs when fatty material (plaque) builds up on the walls of your arteries and makes them narrower. The walls of the arteries also become stiffer and cannot widen (dilate) to allow greater blood flow when needed.
Atherosclerosis, sometimes called "hardening of the arteries," occurs when fat, cholesterol, and other substances build up in the walls of arteries. ...
As a result, the muscles of your legs cannot get enough blood and oxygen when they are working harder (such as during exercise or walking). If PAD becomes severe, there may not be enough blood and oxygen, even when the muscles are resting.
PAD is a common disorder. It most often affects men over age 50, but women can have it as well. People are at higher risk if they have a history of:
The main symptoms of PAD are pain, achiness, fatigue, burning, or discomfort in the muscles of your feet, calves, or thighs. These symptoms most often appear during walking or exercise, and go away after several minutes of rest.
At first, these symptoms may appear only when you walk uphill, walk faster, or walk for longer distances.
Slowly, these symptoms occur more quickly and with less exercise.
Your legs or feet may feel numb when you are at rest. The legs also may feel cool to the touch, and the skin may look pale.
When PAD becomes severe, you may have:
Pain and cramps at night
Pain or tingling in the feet or toes, which can be so severe that even the weight of clothes or bed sheets is painful
Pain that is worse when you elevate your legs, and improves when you dangle your legs over the side of the bed
Balance exercise with rest. Walk or do another activity to the point of pain and alternate it with rest periods. Over time, your circulation may improve as new, small blood vessels form. Always talk to the provider before starting an exercise program.
Stop smoking. Smoking narrows the arteries, decreases the blood’s ability to carry oxygen, and increases the risk of forming clots (thrombi and emboli).
Thrombi and emboli
Blood clots are clumps that occur when blood hardens from a liquid to a solid. A blood clot that forms inside one of your veins or arteries is calle...
Take care of your feet, especially if you also have diabetes. Wear shoes that fit properly. Pay attention to any cuts, scrapes, or injuries, and see your provider right away. Tissues heal slowly and are more likely to get infected when there is decreased circulation.
Monitor your blood sugar level if you have diabetes, and keep it under control.
Medicines may be needed to control the disorder, including:
Aspirin or a medicine called clopidogrel (Plavix), which keeps your blood from forming clots in your arteries. DO NOT stop taking these medicines without first talking with your provider.
Cilostazol, a drug that works to enlarge (dilate) the affected artery or arteries for moderate-to-severe cases that are not candidates for surgery.
Medicine to help lower your cholesterol.
If you are taking medicines for high blood pressure or diabetes, take them as your provider has prescribed.
Surgery may be performed if the condition is severe and is affecting your ability to work or do important activities, you are having pain at rest, or you have sores or ulcers on your leg that do not heal. Options are:
Most cases of PAD of the legs can be controlled without surgery. Although surgery provides good symptom relief in severe cases, angioplasty and stenting procedures are being used in place of surgery more and more often.
Bonaca MP, Creager MA. Peripheral artery disease. In: Zipes DP, Libby P, Bonow RO, Mann DL, Tomaselli GF, Braunwald E, eds. Braunwald's Heart Disease: A Textbook of Cardiovascular Medicine. 11th ed. Philadelphia, PA: Elsevier Saunders; 2019:chap 64.
Murphy TP, Cutlip DE, Regensteiner JG, et al. Supervised exercise, stent revascularization, or medical therapy for claudication due to aortoiliac peripheral artery disease: the CLEVER study. J Am Coll Cardiol. 2015;65(10):999-1009 PMID: 25766947 www.ncbi.nlm.nih.gov/pubmed/25766947.
Simons JP, Robinson WP, Schanzer A. Lower extremity arterial disease: medical management and decision making. In: Sidawy AN, Perler BA, eds. Rutherford's Vascular Surgery and Endovascular Therapy. 9th ed. Philadelphia, PA: Elsevier; 2019:chap 105.
Deepak Sudheendra, MD, FSIR, RPVI, Assistant Professor of Interventional Radiology & Surgery at the University of Pennsylvania Perelman School of Medicine, with an expertise in Vascular Interventional Radiology & Surgical Critical Care, Philadelphia, PA. Review provided by VeriMed Healthcare Network. Also reviewed by David Zieve, MD, MHA, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team. Editorial update 09/04/2019.