Peripheral Arterial Disease

Peripheral Arterial Disease (PAD) affects 8 million people in the United States. In this disease, arteries, primarily in the legs, become blocked with fatty deposits called plaque. This is a similar process to the build-up of plaque in the arteries of the heart. Both are forms of atherosclerosis, the hardening and narrowing of the arteries.   

Risk Factors

  • Smoking
  • Diabetes
  • High cholesterol
  • High blood pressure
  • Age
  • Family history of heart disease, stroke, heart and vascular disease


In many instances, there are no symptoms. For others, there are telltale signs. These can include:

  • Pain, tightness, or cramping in the legs brought on by walking and relieved by rest
  • A non-healing ulcer of the foot
  • Pain in the feet which is constant and commonly felt at night


Peripheral Arterial Disease is diagnosed through a physical examination. Most frequently, a physician will perform an ankle-brachial index (ABI) test. In this examination, the blood pressure in the patient's feet is compared to the blood pressure in the arms to determine how well blood is flowing. Normally, the pressure in the ankles is at least 90 percent of the arm pressure. However, in patients with severely narrowed arteries, it can be as low as 50 percent. In the event that an ABI test reveals an abnormal blood pressure ratio between the ankle and arm, more tests may be performed to provide the physician with additional information. These may include:

  • Doppler and ultrasound duplex imaging
  • CT angiography
  • Magnetic resonance angiography (MRA)


Risk factor modification is the first-line treatment. With a physician's guidance and appropriate medication, a regimen of walking and leg exercises can produce beneficial results for some patients in a matter of months.

Should exercise and dietary modification fail to resolve the symptoms, a minimally invasive procedure, called angioplasty, can often be performed. In this procedure, a catheter is threaded to the site of a blockage and a balloon is inflated to open the narrowed artery. Often a small metal scaffold, called a stent, is then implanted to keep the artery open following the procedure. If a lengthy portion of artery is blocked, bypass surgery may be necessary to restore normal blood flow. In this operation, a vein or an artificial blood vessel is used to reroute blood around the site of the blockage.