Peripheral artery disease (PAD) is a condition characterized by reduced blood flow due to artery blockages, primarily caused by atherosclerosis, and is most commonly found in the legs. Symptoms include cold or shiny skin, pain during activity, non-healing ulcers, and diminished pulses, with risk factors such as smoking, diabetes, and high cholesterol. Untreated PAD poses serious health risks, including potential amputation and increased likelihood of coronary artery disease, stroke, and heart attacks.

1. PeripheralArtery Disease
A blockage in the arteries causing blood flow to be diminished.

2. Artery Blockage
• Atherosclerosis - Build up of lipids and fibrous material (plaque) under
the lining of the blood vessel.
• Blockage usually builds over the course of many years.
• Blood clot (embolism) can also block arterial blood flow.

3. Atherosclerosis
• Peripheral artery disease can occur in any blood vessel. However, it is most
common in the legs.
• Lower extremity peripheral artery disease is usually caused by
atherosclerosis.
• The obstruction of the internal lining of a blood vessel could lead to skin
changes, limb pain, non-healing wounds, and poor muscle perfusion.
• Insufficient tissue perfusion results in the hardening of the arteries.

4. PAD Symptoms - Characteristics
• Cool or cold skin. Hairless, dry, or shiny skin.
• Sharp or stabbing pain. Gets worse with activity. Lowering feet may relieve
pain.
• Severely painful ulcers. Pale, gray base ulcers found of heels, toes, dorsum
of the foot.
• Pulse is either diminished or absent.
• Edema is infrequent.

5. Warning Signs and Symptoms
• Severe pain or numbness in the legs and feet while not moving.
• Noticeable decrease in temperature of lower leg or foot.
• Foot or toe sores, infections or ulcers that do not heal or heal slowly.
• Thickening of the toenails
• Absent or diminished pulse in foot or leg
• Possible gangrene.

6. PAD Risk Factors
• History of smoking
• Diabetes
• Increased age
• High blood pressure
• Excess weight
• Family history of peripheral artery disease
• High cholesterol

7. Risk Factors (continued)
The major risk factors and causes of PAD are the same as those for atherosclerosis
involved in the neck and coronary arteries.
The presence of three or more factors confers a 10-fold increase in PAD risk.1
PAD often goes undiagnosed. Untreated PAD can be dangerous because it can not
only lead to amputation, but patients with PAD have an increased risk of coronary
artery disease, stroke and heart attack.

8. PAD Effects
When muscles fail to get sufficient nutrients and oxygen during exercise, a cramping
discomfort referred to as claudication is likely to occur.
Intermittent claudication (IC), is the hallmark of PAD and is defined as fatigue,
discomfort, cramping, or pain of vascular origin in the calf muscles of the lower
extremities that is consistently induced by exercise and consistently relieved within
10 minutes by rest.
Blood flow can reach the tissue through smaller, collateral vessels by going around
the blockage. In this case, people my appear asymptomatic until walking or exercising
when the leg muscles demand more oxygen that the smaller vessels can supply.

9. Intermittent Claudication (IC)
In the general population:
• only about 10% of persons with known PAD have the classic symptom of
intermittent claudication.
• Approximately 40% do not complain of leg symptoms at all
• 50% have a variety of leg symptoms different from classic claudication3

10. National Diabetes Statistics
• Among the US population overall, crude estimates for 2018 were: 34.2 million people of all ages—or
10.5% of the US population—had diabetes.
• The percentage of adults with diabetes increased with age, reaching 26.8% among those aged 65
years or older.
• The number of Americans diagnosed with diabetes has risen from 1.5 million in 1958 to 18.8 million in
2010, an increase of epidemic proportions.
Source: https://www.cdc.gov/diabetes/pdfs/data/statistics/national-diabetes-statistics-report.pdf