Harvard Men's Health Watch

Peripheral artery disease: Leg pain and much more

Arteries are the vital channels that carry oxygen-rich blood from the heart to all the body's tissues. When blockages develop, blood flow slows and tissues suffer. Blockages in the coronary arteries cause angina and heart attacks; blockages in the arteries that supply blood to the brain cause strokes. But the peripheral arteries that carry blood to the legs and other parts of the body are also vulnerable. Heart attacks and strokes get all the publicity, but peripheral artery disease (PAD) is a major problem that deserves more attention and respect — especially since new methods make diagnosis easier and treatment better than ever before.

What is PAD?

Like most strokes and nearly all heart attacks, PAD (sometimes called peripheral vascular disease) is a form of atherosclerosis. The disease begins when LDL ("bad") cholesterol passes from the blood into the wall of an artery. Arteries damaged by high blood pressure, smoking, or diabetes are at particular risk. As the cholesterol builds up, it triggers inflammation, which adds to the damage. Unless treatment halts the process, the cholesterol deposit builds up into a plaque, or blockage, that narrows the artery. Mild narrowing may not produce any symptoms, but moderate narrowing may prevent tissues from getting the blood they need to fuel the extra work of exercise. When blockages are severe, the tissues suffer even during rest. Blood clots can add insult to injury by increasing blockages.

PAD is much more common in the legs than anyplace else. The most frequently affected locations include the aorta (about 30%), the femoral and popliteal arteries (80%), and the tibial artery (40% — because men can have blockages in several arteries, the numbers add up to over 100%; see figure).

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