Peripheral Artery Disease

What is peripheral artery disease?

The human body depends on healthy blood flow to keep all its parts working. Blood carries oxygen and other essential resources from the heart and lungs out to the arms and legs. Peripheral artery disease (PAD) is a condition in which blood flow to your limbs is reduced. 

PAD is typically caused by the buildup of fatty plaque deposits in the arteries (atherosclerosis), narrowing them and restricting blood flow. This condition most often affects the legs, but it can also occur in the arms. In severe cases, reduced circulation can lead to chronic wounds, tissue damage, or infection. Severe PAD sometimes requires limb amputation if not properly managed.

One of the most common early signs of PAD is claudication, a term that comes from the Latin word claudicare, meaning "to limp." Claudication causes pain, cramping, or fatigue in your legs while walking or exercising. It occurs because your muscles aren’t getting enough oxygen-rich blood during physical activity.

If PAD progresses, it can lead to critical limb ischemia (CLI), a more serious form of the disease. People with CLI may feel pain even at rest, develop wounds that don’t heal, or see changes in skin color or temperature in the affected limb. Without proper treatment, CLI significantly increases the risk of limb loss.

Early diagnosis and care for PAD are important because it is a treatable condition, and catching it early can help prevent claudication from progressing into CLI. Monitoring for PAD is especially important for patients living with high blood pressure, diabetes, or kidney disease, smokers, and patients with a history of heart or vascular disease.

An estimated 8.5 million people in the United States are living with peripheral artery disease (PAD), and many are unaware they have it, according to data from the Centers for Disease Control and Prevention (CDC) and the American Heart Association.

At Mass General Brigham Heart and Vascular, our specialists focus on early intervention and limb-saving therapies designed to improve circulation, promote healing, mitigate risk of complications, and slow or stop disease progression.
 

What are peripheral artery disease symptoms?

Symptoms of PAD are often minimal at first and may go unnoticed until the condition has significantly progressed. Many patients don’t notice symptoms until an affected artery has narrowed by 50% or more.

In addition to claudication (limb pain with movement that goes away with rest), other common signs of peripheral artery disease in the affected limb include:

• Coldness
• Pain with movement or exercising
• Muscle atrophy, or loss of muscle size and strength due to poor blood flow
• Tingling or numbness
• Slow-healing or open sores

Peripheral artery disease complications

This condition can worsen over time, especially in cases where the cause of peripheral artery disease is atherosclerosis. Plaque buildup within the arteries can ultimately lead to stroke or heart failure.

Critical limb ischemia is another serious potential complication of PAD. This occurs when blood flow to a limb becomes severely restricted, and poor circulation makes it harder for the body to fight infection and repair tissue damage. If left untreated, this can result in tissue death (necrosis and gangrene) and may require amputation to prevent the spread of infection and save the patient’s life.

In severe cases, when tissue damage is too advanced or infection cannot be controlled, amputation may be recommended as a last resort to protect the patient’s overall health. Our team explores every other option first. For those who do require amputation, we provide expert rehabilitation, follow-up care, and ongoing support throughout recovery.

What causes peripheral artery disease?

Atherosclerosis is the leading cause of peripheral artery disease. But it can also be caused by:

• Inflamed arteries: Inflammation of the arteries can restrict blood flow and lead to peripheral artery disease. However, it is less common than PAD caused by atherosclerosis, and, in some cases, may heal more quickly. Inflamed arteries can be caused by:
  • Autoimmune and vascular diseases, such as giant cell arteritis, lupus, polyarteritis nodosa, rheumatoid arthritis, and takayasu arteritis
  • Certain chemotherapy drugs
  • Diabetes
  • Drugs
  • Exposure to toxins
  • Infections, including STIs, COVID-19, and hepatitis B or C
  • Obesity
  • Sedentary lifestyle
  • Smoking
• Trauma: Injuries to the limbs or their arteries may cause this condition in some cases.

What are peripheral artery disease risk factors?

Because atherosclerosis can cause peripheral artery disease, PAD risk factors overlap with atherosclerosis.

• Family history of artery disease, heart disease, or stroke
• Over 60 years old
• Diabetes
• High blood pressure
• High cholesterol
• Smoking or using nicotine products
• Unhealthy or excessive body weight

If you have any of these risk factors, talk to your primary care provider. They may recommend screening you for PAD and/or refer you to a vascular specialist for early monitoring. Early detection makes a significant difference in preventing complications.

How is peripheral artery disease diagnosed?

If you’ve been experiencing symptoms of peripheral artery disease, your physician will want to examine you and check the pulse in your limbs. Your doctor may refer you to a Mass General Brigham vascular specialist for further diagnostic testing. 

To diagnose PAD accurately, our specialists use noninvasive tests that can be performed during your first office visit. These tests include:

• Ankle-brachial index (ABI), a test that compares blood pressure at the ankle and in the arm to determine the severity of PAD
• Pulse volume recording, a noninvasive technique developed by clinicians at Mass General to measure the blood flow in the arms and legs
• Duplex ultrasound, which uses sound waves to evaluate blood flow
• Computed tomography angiography, a type of imaging test that uses an injectable dye to create detailed images of your blood vessels and tissue
• Magnetic resonance angiography, a type of MRI that provides images of blood vessels

Request an appointment with the Mass General Brigham vascular team to learn more about your options for diagnosing and treating PAD.

What are peripheral artery disease treatments?

Treatment for PAD depends on how far the condition has progressed and how it’s affecting your daily life. In many cases, making healthy lifestyle changes and taking medications can go a long way in improving symptoms and preventing the disease from getting worse. When more advanced care is needed, our specialists offer a range of minimally invasive and surgical treatments to improve blood flow and help you stay active.

The goal of PAD treatment is to restore healthy blood flow to the legs and feet and reduce the risk of future complications. Most patients will begin with medical therapies that include cholesterol-lowering medications (statins), blood thinners, and support for quitting smoking when applicable. Our specialists may also recommend one or more of the following treatment options.

We are committed to using every available option to help you avoid amputation. If amputation does become necessary, our focus shifts to preserving the health of your remaining limbs and preventing further disease progression.

How to prevent peripheral artery disease

PAD is most often caused by atherosclerosis, a condition in which fatty plaque builds up inside the arteries and limits blood flow. Taking steps to reduce your risk of atherosclerosis can also help prevent PAD. Healthy lifestyle choices play a big role in keeping your arteries clear and your circulation strong.

Here are a few ways to lower your risk:

• Avoid smoking and nicotine products
• Stay physically active with regular exercise
• Manage high blood pressure with lifestyle changes and/or medication
• Keep cholesterol levels in a healthy range through diet or medications

Living well with peripheral artery disease

If you've been diagnosed with PAD, making some of the same healthy choices listed above can help reduce your symptoms and slow the disease’s progression. Even small changes can improve how far you can walk without pain and lower your risk of serious complications.

Talk with your Mass General Brigham care team about the best ways to manage PAD based on your needs and lifestyle. They may recommend medications, a walking program, or other treatments to help improve circulation. 

It’s also important to take extra care of your legs and feet. Because PAD limits blood flow, injuries may take longer to heal and have a higher chance of becoming infected. Keeping your skin healthy and checking for cuts or sores regularly can help avoid further problems.

The Mass General Brigham difference

Mass General Brigham offers one of the most advanced and comprehensive programs in the country for treating PAD, with a strong emphasis on limb evaluation and preservation. Led by Anahita Dua, MD, our multidisciplinary team brings deep expertise and research-driven innovation to every aspect of care. Our facilities are equipped with cutting-edge tools, like shockwave therapy and the latest atherectomy devices, and we offer access to promising clinical trials, including the testing of new technologies like plaque-dissolving lasers and novel approaches to deep venous arterialization.

We are also home to the only comprehensive vascular health program in the U.S. specifically designed to care for people without stable housing. No matter your situation, our goal is always the same: to protect your limbs, preserve your mobility, and support your long-term health.

Our team

Mass General Brigham Heart and Vascular brings together a team of experts from across specialties to create the right treatment plan for you. In addition to experts in vascular medicine, surgery and imaging, our PAD care team includes clinicians with backgrounds in endocrinology, infectious disease, interventional cardiology and radiology, nursing, nutrition, physical medicine and rehabilitation, physical therapy, podiatry, prosthetics and wound care. This multidisciplinary approach ensures comprehensive treatment for those living with peripheral artery disease.

To enhance your patient experience across our health system, a liaison nurse will help coordinate and support your care. 

Clinical trials for peripheral artery disease

Mass General Brigham participates in major clinical studies that evaluate new technologies and devices to treat PAD. This allows us to bring our patients promising new treatments as quickly as possible, such as:

• New and cutting-edge endovascular devices: Since 1997, Mass General’s vascular ultrasound core laboratory (VasCore) has been a leader in the design, development and implementation of clinical trials on new endovascular devices.
• Drug-eluting stents and drug-coated balloons: Our clinicians are investigating the health benefits of drug-eluting stents (stents that slowly release medication to prevent recurring blockage) and drug-coated balloons that can keep arteries open longer after PAD treatments and procedures
• Advanced surgical and endovascular treatment options: Our physicians are leading national investigative efforts to determine the roles of surgical and endovascular procedures—such as pedal access procedures and deep venous arterialization for limb salvage in “no-option” extremities—in patients with the most advanced forms of CLI.

Peripheral artery disease FAQs