Overview

Peripheral artery disease (PAD) is a chronic circulatory condition in which arteries outside the heart and brain become narrowed or blocked, most commonly in the legs. The reduced blood flow can cause muscle pain during exertion, slow healing of foot wounds, and in advanced cases tissue loss. PAD is closely linked to systemic atherosclerosis and is an indicator of increased risk for heart attack and stroke. The condition is referred to by several names, including peripheral arterial occlusive disease, peripheral obliterative arteriopathy, or peripheral vascular disease.

Causes and risk factors

PAD arises when fatty deposits (atheroma) build up on artery walls, narrowing the vessel lumen and limiting blood flow. Major risk factors include smoking, diabetes, high blood pressure, high cholesterol, older age, and a family history of vascular disease. People with one vascular problem often have disease elsewhere, so PAD should prompt evaluation of cardiac and cerebrovascular risk.

Signs and symptoms

Early PAD can be asymptomatic. The classic symptom is claudication—cramping or aching in the calf, thigh or buttock that appears with walking and eases with rest. Other warning signs include numbness, coldness or discoloration in the feet or toes, slow-healing ulcers, and hair loss on the legs. In severe or untreated PAD, rest pain and gangrene may develop, which can require urgent intervention or amputation.

Diagnosis

Assessment begins with a focused history and physical exam, including pulses in the feet. Simple bedside tests such as the ankle–brachial index (ABI) compare blood pressure in the ankle and arm and help confirm reduced limb perfusion. Further evaluation may include duplex ultrasound, computed tomography (CT) angiography, magnetic resonance (MR) angiography, or conventional catheter angiography when planning revascularization.

Treatment and management

Treatment aims to relieve symptoms, heal wounds, and reduce cardiovascular risk. Typical components are:

  • Risk factor modification: smoking cessation, glycemic and blood pressure control, and lipid-lowering therapy.
  • Exercise therapy: supervised walking programs improve walking distance and quality of life.
  • Medications: antiplatelet agents, statins, and drugs to improve walking distance in selected patients.
  • Revascularization: endovascular procedures (angioplasty, stenting) or bypass surgery for lifestyle-limiting claudication or limb-threatening ischemia.

Prognosis, prevention and important distinctions

PAD is a marker of systemic atherosclerosis and carries elevated risk of myocardial infarction and stroke, so long-term management targets overall vascular health. Early detection and aggressive modification of risk factors improve outcomes and may prevent progression to critical limb ischemia. Because the term PAD overlaps with broader peripheral arterial disease concepts, clinicians distinguish it from venous disorders and from neuropathic causes of foot problems. Educational resources and clinical guidelines can provide local diagnostic and treatment pathways—see clinical references and practice resources such as vascular imaging and testing guides and patient-directed information about symptoms in the legs.