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Peripheral artery disease - legs

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 leads to narrowing and hardening of the arteries. This causes decreased blood flow, which can injure nerves and other tissues.

Images

Arteriosclerosis of the extremities

Presentation

Arterial bypass leg - series - Normal anatomy

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Causes

PAD is caused by "hardening of the arteries." 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.

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:

Symptoms

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.

When PAD becomes severe, you may have:

Exams and Tests

During an exam, the health care provider may find:

When PAD is more severe, findings may include:

Blood tests may show high cholesterol or diabetes.

Tests for PAD include:

Treatment

Things you can do to control PAD include:

Medicines may be needed to control the disorder, including:

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:

Some people with PAD may need to have the limb removed (amputated).

Outlook (Prognosis)

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.

Possible Complications

Complications may include:

When to Contact a Medical Professional

Call your provider if you have:

Related Information

Hardening of the arteries
Stroke
Diabetes
High blood pressure - adults
Ulcers
Gas gangrene
Arterial embolism
Angioplasty and stent placement - peripheral arteries
Peripheral artery bypass - leg
Leg or foot amputation
Angioplasty and stent placement - peripheral arteries - discharge
Peripheral artery bypass - leg - discharge
Foot amputation - discharge
Leg amputation - discharge
Leg or foot amputation - dressing change
Cholesterol and lifestyle
Antiplatelet drugs - P2Y12 inhibitors
Dietary fats explained
Fast food tips
How to read food labels
Mediterranean diet

References

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.

White CJ. Atherosclerotic peripheral arterial disease. In: Goldman L, Schafer AI, eds. Goldman-Cecil Medicine. 25th ed. Philadelphia, PA: Elsevier Saunders; 2016:chap 79.

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Review Date: 6/10/2018  

Reviewed By: 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.

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