How to recognise signs of peripheral artery disease (PAD)?

Peripheral artery disease (PAD) is a cardiovascular condition where the blood flow to the arms or legs is reduced due to narrowed arteries. It can progress undetected for a long time as it is frequently asymptomatic and many patients are diagnosed only when they already have symptoms of the advanced stage of the disease. Fortunately, there are fast and effective diagnostic tools for preventive screening.

It is estimated that about 40% of patients with PAD are entirely asymptomatic, about half of them have symptoms that could be attributed to other medical conditions, and only 10% have symptoms typical for the disease [1, 2]. There are 230 million people with this disease worldwide; many of them have no symptoms and is therefore without treatment, which could delay or mitigate more sever stages and reduce the risk of serious outcomes like stroke, leg amputations and death [3].

Despite the high prevalence of asymptomatic patients, there are groups who are more likely to be affected by this disease: smokers, diabetics, individuals with a family history of the disease, and patients with other cardiovascular diseases.

Common symptoms of PAD

  • Intermittent claudication. The most common and typical symptom (in symptomatic patients) of PAD manifests as cramping, pain in calf muscles (can also be felt in the buttocks, thighs or feet) while walking or exercising. The pain/discomfort usually subsides when the patient takes a rest – hence intermittent [4].
  • Weak or entirely absent pulse in the legs and feet. Abnormal pulse in the posterior tibial artery has a 48.7% predictive value for PAD [5].
  • The colour of the skin on the affected leg changing to a blueish or pale hue. Individuals with moderate to severe PAD often exhibit unusual pallor in the affected leg when it is in an elevated position (during examination) [6].
  • Lower temperature in the affected leg (in comparison with the unaffected limb or the rest of the body).
  • Scaly and shiny skin on the affected leg. Skin texture is noticeably different on the affected leg(s) in comparison with the non-affected limb or the leg of a healthy individual.
  • Poor toenail and hair growth on the affected leg. Diminished flow of nutrients in the blood to the lower extremities leads to stunted growth or malformation of toenails and even complete hair loss.
  • Sores, ulcers and wounds on the feet, usually non-healing in nature. Most typical for PAD are arterial insufficiency ulcers (also known as ischaemic ulcers), which are the second most common type (10 to 30% of all cases of ulceration) of lower-extremity ulcers [7].
  • Gangrene. The most extreme and obvious symptom/complication of PAD that ultimately requires partial or complete amputation of the affected limb to save life [8].
  • Erectile dysfunction in men, especially if they are diabetic. There is a strong correlation between PAD and erectile dysfunction (ED), with one study showing that the likelihood of individuals with ED also having PAD was twofold compared to the control group without ED [9].

Knowing the symptoms of PAD is necessary to detect it. Since the condition is without symptoms many times, it is advisable to perform the Ankle-Brachial Index measurement, especially if a patient belongs to one of the risk groups. The Ankle-Brachial Index measurement takes just one minute with the MESI mTABLET ABI.