The narrowing and hardening of arteries, known as atherosclerosis, can lead to various circulatory disorders. When atherosclerosis results in decreased blood flow to the heart, it can cause coronary artery disease and a heart attack.

Atherosclerosis that reduces blood flow to the limbs is known as peripheral arterial disease (PAD). This disorder primarily affects the legs, reducing their supply of oxygen and nutrition. It can increase the risk of infection and extend healing time when injuries occur.

PAD also can make walking difficult, and cause skin discoloration, skin or nail abnormalities, and foot sores from the reduced circulation. PAD is the leading cause of limb loss among patients with circulatory problems. Therefore it is important to treat peripheral arterial disease in a timely manner to prevent disability and allow the patient to lead an independent lifestyle.

A variety of methods exists for treating PAD, from self-care to medical management to a range of surgical procedures. .

Early in life, our arteries are smooth, unobstructed vessels. However, with aging and other factors such as high cholesterol level, smoking and diabetes, arteries can narrow and obstruct blood flow. Fatty deposits called plaques collect in the arteries over time, causing them to harden – a process known as atherosclerosis.

The process can affect any artery, raising the risk of heart disease and stroke. When the process reduces blood flow to the limbs, it is called peripheral arterial disease (PAD). The condition may also increase risk of blood clots and infection.

Risk factors are those things that increase the probability of developing peripheral arterial disease: 

• Smoking: People who smoke increase their risk of developing peripheral arterial disease by three to five times. By quitting smoking, a person can significantly reduce his risk.
• High blood pressure (hypertension) can increase the risk of PAD, stroke and coronary artery disease.
• A diet high in cholesterol increases the likelihood of plaque buildup in the blood vessels and increased incidence of atherosclerosis.
• Diabetes results in the inability to control blood sugar levels.
• Excessive weight or obesity
• Family history of heart or circulatory disease

If you have any of these risk factors, be alert for signs of peripheral arterial disease, including calf pain after walking or infection in the feet or legs.

In seeking clues to peripheral arterial disease, the physician will perform a full medical exam as well as review key points of your medical history. This involves checking for circulatory abnormalities and measuring your blood pressure. The physician also may perform any the following:

• Examine the hair, skin and nails for evidence of circulatory difficulties, such as discoloration or poor wound healing 
• Blood tests to check for heart disease, high cholesterol or diabetes 
• Angiography shows blood flow through the arteries by using a contrast dye that is injected into the blood vessels. X-rays are used to take images of the circulating contrast dye. The images allow the doctor to check for the severity and the location of the blockage. 
• Electrocardiogram (ECG) measures the electrical impulses generated by the heart. This test helps to assess whether heart disease is involved in peripheral arterial disease. The ECG may be done as part of a treadmill test, during which the heart is monitored during physical exertion. 
• Ankle-brachial index compares the blood pressure in the arms to that of the legs. The entire test takes about 10-15 minutes and may be done in conjunction with a treadmill test. If blood flow is normal, the two regions’ results will be similar. Peripheral arterial disease will result in differences in the two readings, which the test will reveal; it might also pinpoint the location of a blockage. The test also is used to monitor PAD’s progress. 
• The doctor will use a stethoscope to listen for a bruit (broo-E), a whooshing sound that indicates a narrowed artery. 
• The Doppler ultrasound measures sound waves using a specialized cuff that monitors blood flow in the veins and arteries in the arms and legs. The Doppler ultrasound test can help determine the severity of PAD.
  

Peripheral arterial disease is a serious disease whose symptoms can be managed if caught early. Without treatment, PAD can create several serious complications, including: 

• Open sores and infection of the feet and legs
• Critical limb ischemia, which can cause tissue death
• Coronary artery disease and heart attack
• Stroke
• Transient ischemic attack ("mini stroke")

With early intervention and regular screening, disability from PAD can be prevented. Changes in lifestyle, appropriate medication, and surgical intervention can slow the progress of the condition and to prevent serious complications.

The goal of self-care is to manage the symptoms associated with peripheral arterial disease:

• Maintain regular physical activity, including an exercise program under the advice of a physician or physical therapist. Consider a walking routine, building up to 30 minutes per day, and stretching.
• Stop smoking.
• Eat a well-balanced, heart-healthy (low-salt, low-fat) diet. Following such a diet can reduce blood pressure, blood cholesterol and blood sugar levels.
• Maintain a healthy weight.
• Check feet and legs carefully for any signs of infection or color changes in the skin. If you notice an injury or sore, bring it to the attention of your health-care provider.

Self-care often is combined with other treatment therapies. The doctor will continue to monitor your disease and check for signs of complications. While peripheral arterial disease is serious, it can be managed.