Peripheral artery disease (PAD), or peripheral vascular disease (PVD), is a condition that affects the arteries of the body to the arms, head, and especially those carrying blood to the legs. Cholesterol buildup (atherosclerosis) deposits inside these arteries, leading to progressive narrowing.

When the arteries are significantly blocked, symptoms of pain, coldness, and cramping pain can occur.  Blocked arteries in the neck can lead to stroke or mini-stroke symptoms.  Typically, patients experience discomfort such as pain, cramping or heaviness in the legs and calves that are brought on by walking and relieved by rest (termed claudication). The pulse in the legs is diminished and sometime a bruit (whooshing sound) may be heart by your physician.

In more advanced stages of the disease, blood supply to the skin may be diminished, and thinning of the skin with hair loss and formation of wounds (ulcers) may ensue. Healing of these wounds is delayed or impossible due to poor blood flow. In some cases, tissue death (gangrene) may follow, which sometimes warrants amputation of the digit or limb.

Conditions that predispose to development of PAD are: 

• smoking tobacco
• high blood pressure
• diabetes
• family history
• elevated cholesterol.

Treatment for PAD primarily include treatment of the above risk factors, diet and exercise.  Patients with PAD are at increased risk of coronary artery disease, and should be treated as if this disease is also present.  This may include a stress test and taking certain medications such as aspirin or clopidogrel, and cholesterol lowering therapy.  Initial treatment of claudication is exercise, although some medications such as pentoxifylline (Trental) or cilostazol (Pletal) may be helpful.  Starting a walking program and gradually increasing the distance and speed of walking can improve the claudication symptoms. 

If ulcers develop, pain is severe or occurs even with minimal activity or at rest, then interventional procedures are usually needed.  Blood flow can be restored using either percutaneous interventions (angioplasty and stenting, or atherectomy) or surgery (peripheral bypass).

Additional web sites:

Wikipedia

National Institute of Health/NHLBI

Society Interventional Radiology