Peripheral Arterial Disease – Symptoms May be Apparent (or Not)

Peripheral Arterial Disease – Symptoms May be Apparent (or Not)


Sherene Shalhub, MD
Vascular Surgeon

Peripheral arterial disease (PAD) is caused by atherosclerosis, the process of plaque building up in the arteries which carry blood to your head, organs and limbs. Plaque is made up of fat, cholesterol, calcium, fibrous tissue and other substances in the blood. Over time, plaque can harden and narrow the arteries, limiting the flow of blood to your organs and other parts of your body. While PAD usually affects the arteries in the legs, it can also affect those carrying blood from your heart to your head, arms, kidneys and stomach.


What are the symptoms of PAD?
As in Cheryl’s case, blocked blood flow from PAD may cause:
• Discomfort or pain in one or both legs when walking or climbing stairs which goes away with rest (remember not to ignore leg pain—it’s not necessarily just a symptom of aging)
• Cramping, tightness or heaviness in the affected leg, buttocks, thighs, calves and feet
It may also cause:
• Weak or absent pulses in the legs or feet
• Sores or wounds on the toes, feet or legs that heal slowly, poorly, or not at all
• A pale or bluish color to the skin
• A lower temperature in one leg compared to the other leg
• Poor nail growth on the toes and decreased hair growth on the legs
• Erectile dysfunction, especially among men who have diabetes

If you have any of these symptoms, please talk to your doctor.

Even if you don’t have signs or symptoms, ask your doctor if you should get checked for PAD if:
• You’re age 70 or older
• Aged 50 or older and have a history of smoking or diabetes

Why it’s important to diagnose PAD
In addition to causing pain, PAD increases your risk of infection in the affected limbs, coronary heart disease (CHD), heart attack, stroke and transient ischemic attack (mini-stroke). If you have CHD, you have a 1 in 3 chance of having blocked leg arteries. PAD treatment may slow or stop disease progress and reduce the risk of complications. Treatments include lifestyle changes, medicines and surgery or procedures.

What causes PAD?
Risk factors for atherosclerosis include:
• Smoking
• High cholesterol levels in the blood
• High blood pressure
• Obesity
• Having a family history of heart or vascular disease

The best ways to prevent PAD
If you smoke, quit. Smoking is the main risk factor for PAD. Your risk of PAD increases four times if you smoke or have a history of smoking. Talk with your doctor about programs and products that can help you quit smoking. The Health Topics Smoking and Your Heart article and the National Heart, Lung, and Blood Institute’s (NHLBI’s) “Your Guide to a Healthy Heart” both include information about how to quit smoking.
Avoid secondhand smoke.
Follow a healthy diet. Eat a variety of fruits, vegetables and whole grains. A healthy diet also includes lean meats, poultry, fish, beans and fat-free or low-fat milk or milk products. A healthy diet is low in saturated fat, trans fat, cholesterol, salt and added sugar.

Have concerns about any of the symptoms of PAD?
Talk to your primary care physician. Looking for a primary care physician? Visit

Concerned about your vascular health?
Visit or call the Vascular Surgery Clinic at 425.656.5568.