Peripheral artery disease (PAD) occurs when the arteries that carry blood to the legs and feet become narrowed or blocked by atherosclerosis — the same plaque buildup that causes coronary artery disease in the heart. PAD affects roughly 12 million Americans and is seriously underdiagnosed, partly because its signature symptom — leg pain with walking — is so often attributed to normal aging.
The Hallmark Symptom: Claudication
The classic symptom of PAD is intermittent claudication: a cramping, aching, or heavy feeling in the calf, thigh, or buttock that occurs during walking or physical activity and is relieved by rest. The pain is caused by the muscles receiving inadequate blood flow — and therefore insufficient oxygen — during exertion.
As the disease progresses, the amount of activity required to trigger symptoms decreases. In severe cases, pain occurs even at rest (rest pain), and poor circulation can lead to non-healing wounds, tissue death, and limb-threatening gangrene.
- —Calf, thigh, or buttock cramps that start with walking and stop with rest
- —Leg or foot numbness or weakness
- —Coldness in the lower leg or foot, especially compared to the other side
- —Sores on the toes, feet, or legs that heal slowly or not at all
- —Color changes in the legs — pale, bluish, or dark discoloration
- —Hair loss or slowed hair growth on the legs and feet
- —Weak or absent pulse in the legs or feet
Why PAD Is a Systemic Warning Sign
PAD is not just a leg problem. Because atherosclerosis affects the entire arterial system, someone with PAD in the legs almost always has significant atherosclerotic disease elsewhere — including the coronary arteries supplying the heart and the carotid arteries supplying the brain. People with PAD have a two- to four-fold increased risk of heart attack and stroke compared to those without it.
PAD and coronary artery disease share virtually the same risk factors. A diagnosis of PAD should prompt evaluation of cardiovascular risk and often triggers cholesterol and blood pressure optimization.
Risk Factors for PAD
- —Diabetes mellitus — the single strongest risk factor for severe PAD
- —Smoking
- —High blood pressure
- —High cholesterol
- —Age over 65
- —Age over 50 with a history of diabetes or smoking
- —Obesity
- —Family history of heart disease, stroke, or PAD
- —Chronic kidney disease
How PAD Is Diagnosed: The ABI Test
The ankle-brachial index (ABI) is the cornerstone test for diagnosing PAD. It compares blood pressure measured at the ankle to blood pressure measured at the arm. In healthy arteries, these pressures should be similar. When the arteries in the legs are narrowed, the ankle pressure drops relative to the arm pressure.
- —ABI 1.00–1.40: normal
- —ABI 0.91–0.99: borderline — monitoring and risk factor control
- —ABI 0.71–0.90: mild PAD
- —ABI 0.41–0.70: moderate PAD
- —ABI ≤ 0.40: severe PAD — limb-threatening ischemia possible
A full peripheral arterial study (PAS) at Heartwell STAT Imaging goes beyond the ABI to include segmental limb pressures and pulse volume recordings (PVRs), which map the location and severity of blockages along the leg from the hip to the ankle. The exam takes approximately 30 minutes and involves no needles, catheters, or radiation.
Treatment and What to Expect
Mild-to-moderate PAD is typically managed with lifestyle modifications (supervised exercise therapy is highly effective), smoking cessation, antiplatelet medications (aspirin or clopidogrel), and aggressive control of blood pressure, cholesterol, and blood sugar. Revascularization procedures — angioplasty, stenting, or bypass surgery — are reserved for more severe or limb-threatening cases.
If you notice leg cramps, fatigue, or pain with walking — particularly if you have diabetes, a history of smoking, or are over 65 — a peripheral arterial study at Heartwell STAT Imaging can provide answers the same day.