Peripheral Arterial Disease

What is PAD?

Peripheral arterial disease (PAD) happens when fatty deposits build up in the arteries that carry blood to your legs. This makes the arteries narrower, so less blood can get through to your leg muscles. It's sometimes called peripheral vascular disease (PVD).

What symptoms might you notice?

Many people with PAD don't have any symptoms at all. But some people develop leg pain when they walk that goes away when they rest. This is the most common sign.

The pain usually:

• Happens when you're walking or exercising
• Goes away after a few minutes of rest
• Can range from mild to quite painful
• Often affects both legs, but may be worse in one

Other symptoms can include:

• Hair loss on your legs and feet
• Numbness or weakness in your legs
• Toenails that grow slowly or become brittle
• Sores on your feet or legs that won't heal
• Skin on your legs changing colour (getting paler or blue)
• Shiny skin on your legs
• Leg muscles getting smaller
• In men, problems getting an erection

These symptoms usually develop slowly over time.

When should you speak to your GP?

Speak to your GP if you get leg pain that keeps coming back when you exercise or walk. Don't assume this is just part of getting older - healthy people shouldn't have leg pain when walking.

Red flag symptoms - get help immediately

Contact your GP straight away, call 111, or go to A&E if you develop:

• Severe burning pain in your legs and feet that won't go away, even when resting
• Skin that turns very pale, shiny, and dry
• Wounds or sores that won't heal
• Toes or feet that become cold, numb, red, then black
• Swelling with bad-smelling discharge

These could be signs of critical limb ischaemia - a very serious condition that needs urgent treatment.

What causes PAD?

PAD is caused by fatty deposits (made of cholesterol and other waste) building up on artery walls. This process is called atherosclerosis - it's the same process that can cause heart attacks and strokes.

Some things make PAD more likely:

• Smoking (the biggest risk factor)
• Diabetes (type 1 or type 2)
• High blood pressure
• High cholesterol
• Getting older

How is PAD treated?

The main treatments are lifestyle changes and medication:

Lifestyle changes:

• Stop smoking (most important)
• Exercise regularly
• Eat a healthy diet
• Lose weight if needed
• Drink less alcohol

Medical treatment:

• Medicine to treat high blood pressure, high cholesterol, or diabetes
• Sometimes surgery to improve blood flow

With treatment, most people's symptoms stay stable or even improve.

Important to know

PAD itself isn't immediately life-threatening, but it does increase your risk of heart disease, stroke, and heart attacks. This is because the same process affecting your leg arteries can affect arteries elsewhere in your body.

Your GP can diagnose PAD by examining you and checking the blood pressure in your arm compared to your ankle.

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Based on NHS.uk guidance. Written by Dr Krishnan Pasupathi, NHS GP.