PAD - Symptoms, Causes, Treatment | Finding the Right Doctor for You

01.04.2021

Peripheral artery diseases, shortened to PAD, is a chronic circulatory condition. Due to a narrowing of or obstruction in the arteries in the legs, blood circulation within the legs becomes impaired. Typically, the first sign of PAD is pain while walking and a decreased ability to walk. The main cause of this condition is atherosclerosis.

Here you can find information about the symptoms, cases, diagnosis, and treatment of PAD as well as recommended PAD specialists.

ICD codes for this diseases: I70.2

Recommended specialists

Brief overview:

  • What is PAD? Peripheral artery disease is a chronic circulatory condition that impairs the circulation within the legs.
  • Causes: Atherosclerosis is the cause in 90% of cases, in which not enough blood can flow through the arteries of the legs. Inflammatory vascular diseases can also trigger this condition.
  • Risk Factors: Risk factors for this condition are the same as those for atherosclerosis, i.e. smoking, diabetes, high blood pressure, and high levels of fat in the blood.
  • Symptoms: The discomfort caused by this condition increases as it progresses. Patients typically feel pain while walking, feelings of weakness or chills in the legs, muscle pains while putting stress on the legs, and later necrosis of the tissue of the toes, knees, and heel.
  • The Four Stages: In stage II, discomfort becomes noticeable, and the patient cannot walk as far as they once could. In stage III, pain while resting begins to occur. In stage IV, tissues begin to die off.
  • Diagnosis: When examining the patient’s body, the doctor checks the pulse in the groin, the back of the knees, the ankles, and the bridge of each foot. Afterwards, the doctor examines the arteries with a Doppler probe and then measures the blood pressure of the foot arteries (Doppler pressure measurement). This is then followed by a duplex ultrasound examination.
  • Treatment: Depending on the stage of PAD, numerous approaches can be considered including medications, walk-training, and dilation of blood vessels with stents as well as vascular operations.
  • Departements for Treatment: Angiology and vascular surgery.

Article overview

Definition: What is PAD?

Peripheral artery disease, or PAD for short, is a chronic circulatory condition. Sclerosis of the leg arteries leads to circulatory disorders and thus a lack of oxygen in the legs. This causes pain while walking and limited mobility.

Those affected by PAD are forced to rest after walking a certain distance until the pain has subsided. They may need to stop in front of shop windows at intervals while out shopping.

Seniorin mit Schmerzen beim Gehen

Those affected have pain in their legs that causes them to take many pauses while walking © Viacheslav Iakobchuk | AdobeStock

PAD is also referred to medically as claudicatio intermittens (latin for temporary limp). Colloquially, this condition is also known as smoker’s leg, because smoking is an important risk factor.

Rates of PAD

PAD is a wide-spread vascular disease. According to the German Society for Angiology (DGA), some 4.5 million people in Germany suffer from PAD. In people who are 65 and older, about 20% are said to be affected by it. Smokers in particular often suffer from PAD.

Senioren Raucher

Smokers and people over 65 in particular are often affected by PAD © Hunor Kristo | AdobeStock

Causes and Risk Factors of PAD

Peripheral arterial disease develops because of a narrowing (stenosis) of or blockage (occlusion) in the arteries of the legs. In 90% of cases, vascular calcification, also known as atherosclerosis, is responsible for it. The other 10% of cases are attributable to inflammatory vascular conditions.

To learn how atherosclerosis and PAD develop, watch the following video: 

The most important risk factors for the development of atherosclerosis and consequently PAD include

Symptoms of PAD

The symptoms depend on how severely the blood vessels have become narrowed or blocked. In the early stages of the condition, the narrowing of the leg arteries is not quite pronounced, so it does not cause many symptoms.

Only when the blood vessels have been narrowed to such an extent that the tissue cannot be supplied with sufficient nutrients or oxygen does pain and discomfort occur. Typical symptoms of PAD include:

  • pain while walking either in the calves, buttocks, or thighs depending on the location in which the blood vessels have become narrowed
  • increasing limitations to the distance one can walk and
  • pain in the feet and toes when resting later on
Schmerzen im Fuß

Calf pain is a typical symptom of PAD © Satjawat | AdobeStock

Other common symptoms of PAD are

  • feelings of coldness and weakness in the legs,
  • coldness and paleness in the affected leg, and
  • muscle pain during exertion

In advanced stages, serious complications like lower leg ulcers and necrosis of the tissue in the toes, ankles, and heel can occur due to a lack of circulation.

Since PAD is caused by atherosclerosis in most cases, PAD patients are also at an increased risk for heart attack or stroke. Heart attacks are the leading cause of death in PAD patients.

Schlaganfall

PAD patients are at an increased risk of stroke © Alexandr Mitiuc | AdobeStock

Stages of Peripheral Artery Disease

Depending on the severity of the symptoms, doctors differentiate between four different stages of PAD:

  • In stage I, there are no discernible symptoms. Doctors also refer to this stage as asymptomatic PAD.
  • In stage II, patients suffer from discomfort while walking and cannot walk distances as far as they once could
  • Stage III is characterized by additional pain while at rest.
  • In stage IV, tissue begins to die away, and this is also called necrosis or gangrene.

At stage III and IV there is an immediate risk of amputation.

Gangrän / Nekrose Fuß

In its latter stages, PAD can cause severe complications such as tissue death (called necrosis or gangrene) in the lower extremities © DOUGLAS | AdobeStock

Diagnosing PAD

If PAD is suspected, a doctor can conduct a series of tests in order to make a diagnosis. Examples of these tests include

  • an examination of the patient’s body, in which the doctor checks the pulse of the affected legs, and
  • using a Doppler ultrasound (Doppler ultrasonography) with a special ultrasound scanner to determine the so-called ankle-brachial index.

If the ankle-brachial index shows that the blood pressure within the ankle is strongly reduced in comparison to the blood pressure of the arm, this indicates a narrowing of the leg arteries and the presence of PAD. With duplex sonography, the doctor can examine the arteries from the pelvis to the feet and, in doing so, assess both the state of the vascular walls and the blood flow within the arteries.

Dopplersonographie

Duplex ultrasound of the leg arteries © New Africa | AdobeStock

Treatment of PAD

The doctor will choose a treatment method depending on the stage of the patient’s PAD. Next, all risk factors must be addressed. This may include giving up nicotine and controlling the blood pressure. Controlled walk-training can also improve symptoms.

For the treatment of PAD, each stage of this condition requires various therapeutic methods including, among other things,

  • medications that encourage blood flow within the vessels,
  • structured walk-training, especially in a PAD-sports groups,
  • Interventional measures like vasodilation with stents and also
  • surgical measures such as a vascular bypass operation

For drug therapy, doctors can prescribe anticoagulants or active ingredients such as acetylsalicylic acid. Surgical options like a vascular bypass operation can only be carried out in later stages of the disease.

The following video shows how a blood vessel is dilated with stents:

Prognosis: Is PAD curable?

Advanced atherosclerosis and therefore PAD is irreversible. However, by beginning treatment early, one can slow down or even entirely stop the progression of the disease. For a good prognosis, the cooperation of the patient is the most important factor. To eliminate risk factors, patients should, among other things,

  • quit smoking,
  • be mindful of their blood sugar, blood pressure, and cholesterol levels,
  • eat a healthy diet,
  • be active,
  • and lose some weight.

Which Specialists treat PAD?

Because PAD is a disease of the blood vessels, experts in the fields of angiology and vascular surgery usually handle its treatment.

Specialists within these two fields are able to use the examination methods listed above to assess whether symptoms are caused by PAD, where the problem areas are, and how circulation can best be restored. Vascular surgeons have the largest spectrum of treatment options, which includes not only conservative treatment methods, but also endovascular methods (like balloon catheters or stents) and open vascular surgeries.

You can find more information about these treatment options here.

Sources:

  • S3-Leitlinie zur Diagnostik, Therapie und Nachsorge der peripheren arteriellen Verschlusskrankheit, https://www.awmf.org/uploads/tx_szleitlinien/065-003m_S3_PAVK_periphere_arterielle_Verschlusskrankheitfinal-2015-11.pdf
  • https://www.dga-gefaessmedizin.de/de/patienten/arterielle-erkrankungen/pavk.html
  • http://www.deutsche-gefaessliga.de/index.php/gefaesserkrankungen/schaufensterkrankheit
  • https://www.diakonissen.de/diakonissen-stiftungs-krankenhaus-speyer/klinik-fuer-gefaesschirurgie/schwerpunkte/arterielle-verschlusskrankheit-pavk-der-beinschlagadern/
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