Peripheral artery disease is a circulatory problem in which narrowed arteries reduce blood flow to the limbs, most often the legs. Many people with PAD have mild symptoms or none at all. Others develop significant leg pain with walking. In its severe form, PAD progresses to critical limb ischemia, and critical limb ischemia is how people lose limbs.
What causes PAD
PAD is caused primarily by atherosclerosis — the buildup of plaque inside the arteries. That plaque, made of fatty material, cholesterol and cellular debris, narrows the channel and reduces the volume of blood that can pass through it. The tissue downstream receives less oxygen than it needs, and it protests.
How PAD affects the legs specifically
The hallmark symptom is claudication: pain or cramping in the leg that appears during walking and settles with rest. Where you feel it depends on where the narrowing is — calf pain typically points to the artery above it, thigh or buttock pain to a blockage higher up.
Beyond claudication, PAD produces a recognizable constellation in the leg and foot: numbness or weakness, coldness in the lower leg or foot compared with the other side, sores or ulcers on the toes, feet or legs that will not heal, changes in the color of the leg, shiny skin over the shin, slowed toenail growth, a diminished or absent pulse in the foot, and, in men, erectile dysfunction from reduced pelvic inflow.
It is worth dwelling on the non-healing wound, because it is the symptom people most often bring in too late. A cut on the foot that has not closed in weeks is not a wound problem. It is a blood supply problem. Tissue cannot heal without circulation, and no amount of dressing changes will substitute for reopening the artery.
Why early detection matters so much
Untreated PAD progresses to critical limb ischemia, a severe reduction in blood flow to the extremity. In severe cases amputation becomes necessary to prevent gangrene and spreading infection. That outcome is almost always preceded by months of symptoms that were explained away.
PAD also carries a message about the rest of the arterial tree. Plaque in the leg arteries is a strong marker of generalized atherosclerosis, which means an elevated risk of heart attack and stroke. Diagnosing PAD is therefore valuable even in someone whose legs do not bother them much.
Who is at risk
Risk rises with smoking, diabetes, high blood pressure, high cholesterol, age over fifty, and a family history of PAD, heart disease or stroke. Smoking deserves particular emphasis: it is both the strongest modifiable risk factor for developing PAD and the strongest predictor that a treated artery will narrow again.
What to do about it
If you have any of these symptoms, see a vascular specialist. The first test — an ankle-brachial index — is painless, takes minutes, and compares the blood pressure at your ankle with the pressure at your arm to quantify how much flow is reaching the foot. Arterial ultrasound adds detail about where the narrowing sits.
Most blockages found this way can be treated from inside the artery, through a needle puncture, without open surgery. What is not optional is the medical side: controlling blood pressure, cholesterol and diabetes, walking regularly, and stopping smoking. Reopening an artery buys time; those measures are what keep it open.
Do not let leg pain, numbness or a wound that will not heal go unchecked. Call us at (212) 991-9991 to schedule an evaluation.