Signs and Symptoms of PAD

Signs of peripheral artery disease include absent or weak pulse, decreased blood pressure, and arterial bruits (sounds heard using a stethoscope) in the affected limb. In many cases, the condition is asymptomatic (i.e., does not cause symptoms). Signs and symptoms of PAD usually affect only one limb or are more severe in one leg than the other.

Pain caused by PAD usually worsens with activity (e.g., walking) and improves with rest. It occurs when muscles do not receive an adequate supply of blood. This pain is called intermittent claudication. "Intermittent" means coming and going or ceasing from time to time, and the term "claudication" comes from a Latin word that means "to limp."

Intermittent claudication often leads to limping or other changes in walking manner (gait). In severe cases, peripheral artery disease causes pain that continues even during periods of inactivity.

Common symptoms of PAD include:

  • Muscle pain (claudication), cramping or a feeling of heaviness in the leg muscles when walking, climbing stairs or doing similar activities, which stops after you rest
  • Difficulty walking
  • Sores (ulcers) or wounds on the lower limbs that do not heal normally
  • Numbness, tingling, and muscle cramps that often occur at rest and disturb your sleep
  • Variations in skin temperature and color (e.g., feeling cold, pale or bluish coloring [called cyanosis])
  • Hair loss or poor nail growth in the affected limb

These symptoms result from inadequate blood flow (circulation). However, PAD does not always cause symptoms, at least not initially, so many people have PAD without knowing it. "One reason a chronic disease like PAD is devastating is because it is silent and progresses slowly," says Patrice Desvigne-Nickens, M.D., Program Director, Heart Failure and Arrhythmias Branch, Division of Cardiovascular Diseases, NHLBI. "You may not realize or believe you are at risk until you become symptomatic. But that's late in the disease, when you are likely to suffer a complication." PAD, she adds, can erode your quality of life and handicap your physical and emotional health. "It's easy to say not me or not now," she adds, "but if you wait until you have symptoms, it's too late. It will get worse unless you take action."

PAD Complications

Peripheral artery disease increases the risk for heart attack, stroke (brain attack), transient ischemic attack (TIA; "mini stroke"), and other serious complications. The risk for complications is higher in patients who have uncontrolled diabetes, high blood pressure, high cholesterol, or severe kidney disease.

PAD complications include the following:

  • Blood clots
  • Erectile dysfunction (impotence)
  • Infection
  • Open sores on the skin (ulcers) that do not heal
  • Pulmonary embolism (blood clot that travels to the lungs)

When blood flow (circulation) is severely reduced, a condition called ischemia results. Ischemia increases the risk for infections that can lead to gangrene (tissue death and decay). Gangrene often requires amputation (surgical removal) of the affected limb.

Publication Review By: Stanley J. Swierzewski, III, M.D.

Published: 14 May 2008

Last Modified: 21 Nov 2012