What is peripheral artery disease?
Peripheral artery disease (PAD) is a condition where the blood vessels that carry blood to your legs (arteries) become narrowed or blocked, usually due to a build-up of fatty deposits. This reduces blood flow to the legs, which can cause pain and other symptoms.
PAD mostly affects the arteries in the legs. It’s a common circulatory problem and becomes more likely with age. PAD doesn’t always cause symptoms, but it can lead to serious complications, such as slow wound healing or in severe cases, limb damage.
The good news is that PAD can often be managed with lifestyle changes, medications, or in some cases, minor procedures.
How peripheral artery disease develops
Peripheral arterial disease (PAD) happens when plaque, made of fat, cholesterol, and other substances builds up in your arteries over time, narrowing or even blocking them. This process is called atherosclerosis.
- Plaque buildup: Artery walls become coated with fatty deposits.
- Reduced blood flow: Muscles get less oxygen, especially during activity.
- Leg pain or cramping: Often occurs when walking and eases with rest (intermittent claudication).
- Worsening symptoms: Pain may appear even at rest as PAD progresses.
- Increased health risks: PAD raises the chance of heart attack or stroke.
With early diagnosis and treatment, PAD can be managed, reducinge symptoms and lower the risk of serious complications.
Who is affected?
PAD can affect anyone, but certain groups are more at risk:
- Adults over 50, especially over 65: As we age, arteries naturally become stiffer and more prone to plaque buildup, increasing the risk of PAD.
- Smokers and former smokers: Tobacco damages the blood vessel walls, encouraging the formation of plaques and narrowing of the arteries.
- People with diabetes: High blood sugar levels can harm blood vessels over time, particularly in the legs and feet, raising PAD risk.
- People with high blood pressure or high cholesterol: Both conditions contribute to artery damage and accelerate atherosclerosis.
- Those with a family history of heart or vascular disease: Genetics play a strong role. If close relatives have had PAD or heart disease, your own risk is higher.
- People with existing cardiovascular disease (like angina or previous heart attack): Atherosclerosis which causes PAD is often part of a broader problem affecting circulation throughout the body.
Men are slightly more likely to develop PAD, though women may experience worse symptoms in later stages, potentially due to underdiagnosis or later detection. Women may also report more atypical symptoms, which can delay treatment.
Signs and symptoms of peripheral artery disease
Common signs and symptoms
PAD can develop slowly, and not everyone has symptoms. When symptoms do appear, they may include:
- Pain, cramping or tiredness in your leg muscles when walking or exercising: This is called intermittent claudication and is one of the most common early signs. It usually affects the calves, but can also be felt in the thighs or buttocks depending on where the blockage is.
- Pain that goes away when you rest: This occurs because your muscles need less oxygen when they’re not being used. As PAD worsens, pain may also occur when resting.
- Numbness, weakness, or a feeling of heaviness in the legs: These symptoms can make walking or standing difficult and may indicate poor nerve or muscle function due to reduced blood flow.
- Cold or pale legs or feet: A clear sign that circulation is limited. One foot may feel colder than the other or look different in colour.
- Sores or wounds on your feet or toes that heal slowly: Poor blood flow means less oxygen and nutrients are reaching your tissues, which slows down the body’s healing process.
- Shiny skin or loss of hair on your legs: Changes in skin texture and hair growth are subtle signs of long-term circulation issues.
- Weak or absent pulse in the feet or legs: Your healthcare provider may check for pulses to assess blood flow. A weak or missing pulse is a red flag for PAD.
When symptoms may worsen
PAD symptoms tend to get worse over time if not treated. They may become more noticeable or flare up in certain situations, such as:
- During physical activity
- In cold weather
- When lying down or elevating your legs (especially if blood flow is very limited)
- If you have other health conditions like diabetes
Causes and risk factors
Common causes
PAD is caused by atherosclerosis – the build-up of fatty plaques in the arteries. These plaques narrow or block blood flow, especially in the arteries that supply the legs. The process of atherosclerosis is gradual and often begins early in life, progressing silently until symptoms arise in adulthood. Several factors can speed up this process:
- Smoking: Tobacco smoke directly damages the inner lining of the arteries, making it easier for cholesterol and fats to stick to the artery walls. It also reduces oxygen in the blood and promotes clot formation.
- High cholesterol: When there is too much LDL ("bad") cholesterol in the blood, it can settle in the artery walls and form plaque.
- High blood pressure: Consistently high pressure can injure artery walls, making them more vulnerable to plaque build-up.
- Diabetes: High blood sugar damages arteries and reduces the body's ability to repair them, accelerating plaque formation.
- Inflammation from conditions like arthritis: Chronic inflammation contributes to atherosclerosis by affecting how the blood vessels function and heal.
Risk factors you should know
Certain factors increase your risk of developing PAD. These include both lifestyle choices and medical conditions:
- Being over 50: Risk increases with age, especially over 65.
- Lack of exercise: Inactivity contributes to weight gain and poor circulation.
- Poor diet (high in fats and sugars): Encourages obesity and worsens cholesterol and blood sugar levels.
- Family history of heart or vascular disease: Genetic factors may predispose you to atherosclerosis or poor circulation.
People with PAD are also at increased risk for coronary artery disease and stroke because the underlying issue (narrowed arteries) can affect multiple areas of the body. Recognising these risks early and making changes can significantly reduce complications.
Red flags for peripheral arterial disease
Peripheral arterial disease symptoms can be subtle at first, but key warning signs require prompt attention.
Key red flags:
- Leg pain or cramping when walking
- Numbness or weakness in the legs
- Cold feet
- Changes in skin colour in the legs or feet
When to seek immediate medical help:
- Severe or persistent leg pain
- Non-healing or infected wounds
- Blackened skin or signs of tissue damage
How peripheral artery disease is diagnosed
Clinical examination
Your doctor will ask about your symptoms, medical history, and lifestyle, including any history of smoking, diabetes, or heart disease. They may examine your legs and feet for signs of poor circulation, such as coldness, pale or bluish skin, thin or shiny skin, slow-growing toenails, or weak or absent pulses in the ankles and feet.
They may also check for any non-healing wounds or ulcers and compare the colour and temperature of both legs. A physical exam helps determine whether further tests are needed to confirm PAD and assess its severity.
Diagnostic tests
Your GP may arrange tests to better understand whether you have PAD:
- Ankle-brachial index (ABI): A quick, non-invasive test that compares blood pressure in your ankle and arm. A lower reading in the ankle suggests reduced blood flow and possible artery narrowing blockage. It's a common first step in PAD diagnosis.
- Ultrasound scan: A duplex ultrasound shows how blood moves through your arteries and highlights any narrowing or blockages. It’s painless and widely used.
- Blood tests: These check for risk factors like high cholesterol, diabetes, and kidney issues, which can affect circulation and worsen PAD.
- Other scans: In complex cases, CT or MR angiography gives detailed images of your arteries using a contrast dye. These are useful for planning treatments like surgery.
Treatment options for peripheral artery disease
Lifestyle changes
Many people with PAD improve significantly through changes such as:
- Stopping smoking: The single most effective way to slow disease progression.
- Exercising regularly: Walking programs are especially helpful. Aim for 30 minutes a day, 5 times a week.
- Eating a heart-healthy diet: Focus on fruits, vegetables, wholegrains, and lean proteins.
- Managing weight: Staying within a healthy range reduces strain on the arteries.
Medication
Medicines can help manage PAD and are often used with lifestyle changes. Your doctor might recommend one or more of the following:
- To improve blood flow and ease leg pain: Medicines like cilostazol can help you walk further without discomfort by relaxing blood vessels.
- To lower cholesterol: Statins help reduce "bad" cholesterol and slow down artery narrowing.
- To control blood pressure: Medicines like ACE inhibitors or beta blockers protect your arteries and ease strain on your heart.
- To manage diabetes: Keeping blood sugar in a healthy range helps protect your blood vessels.
- To prevent blood clots: Medicines like aspirin or clopidogrel make blood less sticky, lowering the chance of clots.
Your doctor will choose the right medicines for you and check how well they’re working over time.
Procedures
If symptoms are severe or not responding to other treatments, your doctor may suggest one of the following revascularisation procedures to restore blood flow:
- Angioplasty and stenting: A small balloon is inserted via keyhole surgery to open up a narrowed artery, often followed by placing a small metal mesh (stent) to keep it open.
- Bypass surgery: A blood vessel from another part of your body or a synthetic graft is used to reroute blood around the blocked artery.
"Revascularisation is a key treatment for peripheral arterial disease by improving blood supply to oxygen-deprived tissues. This improves symptoms, supports wound healing, and helps prevent long-term complications such as limb loss."
Mr Michael Dialynas
Consultant Vascular Surgeon
Can peripheral artery disease be prevented?
While PAD isn't always avoidable, especially if you have a strong family history, many of its risk factors can be reduced through healthy lifestyle choices. Keeping your blood vessels in good shape early on can slow or prevent the condition from developing.
Making small, steady changes like quitting smoking, eating a balanced diet, staying active, and managing diabetes or high blood pressure, can have a big impact. If you’re at higher risk, regular health checks and blood tests can help spot problems early so they can be treated before symptoms start.
Reducing your risks
While PAD can't always be prevented, especially if it runs in your family, you can lower your chances by:
- Stopping smoking
- Managing your blood pressure and cholesterol
- Eating a balanced diet
- Exercising regularly
- Maintaining a healthy weight
- Getting regular check-ups, especially if you have diabetes or a family history of vascular disease
When to seek medical advice
Signs you shouldn't ignore
It's important to speak to your GP or a vascular specialist if you notice any of the following:
- Pain in your legs when walking that improves when you rest
- Pain in your feet when at rest that gets worse during the night
- Wounds or sores on your feet that are slow to heal
- Legs or feet that feel unusually cold or look pale
- You have a history of heart disease or diabetes and are concerned about circulation
Early treatment can improve your symptoms and prevent complications.
Doctors who treat this condition
Peripheral Artery Disease FAQs
How do you treat peripheral artery disease in the legs?
Peripheral artery disease in the legs is treated by improving blood flow and reducing symptoms. Treatments include lifestyle changes like stopping smoking, eating healthily, and regular walking exercise. Medications may be used to lower cholesterol and prevent blood clots. In more serious cases, procedures such as angioplasty, stents, or surgery may be needed.
Can you live a long life with peripheral artery disease?
Yes, people with peripheral artery disease can live a long life with proper management. Healthy lifestyle changes, prescribed medications, and regular check-ups can prevent complications and improve circulation in the legs.
What are the three signs of peripheral arterial disease?
There are three main signs of peripheral arterial disease to watch out for. The first is leg pain or cramping when walking, known as claudication. The second is changes in the skin or temperature of your legs or feet such as coldness, paleness or tight skin. The third is slow-healing wounds or ulcers on the feet, or hair loss on the legs, which can signal poor blood flow and tissue damage.
What are the symptoms of a clogged artery in the leg?
A clogged artery in the leg, often caused by peripheral arterial disease can reduce blood flow and lead to several symptoms. Common signs include leg pain or cramping when walking, known as claudication, numbness or weakness in the legs, skin colour changes and slow healing wounds. Early detection is important to prevent complications and improve circulation.
Related
Varicose veins
Leg ulcers
Chronic venous insufficiency
References
- https://www.nhs.uk/conditions/peripheral-arterial-disease-paad/ [accessed 19.03.26]
- https://cks.nice.org.uk/topics/peripheral-arterial-disease/] ] [accessed 19.03.26]
- https://www.nice.org.uk/guidance/ng158] ] [accessed 19.03.26]
- https://www.heart.org/en/health-topics/peripheral-artery-disease] [accessed 19.03.26]
- https://www.ncbi.nlm.nih.gov/books/NBK430867 [accessed 19.03.26]