Peripheral artery disease (PAD), also called peripheral vascular disease, is a narrowing of the peripheral arteries (arteries outside the heart). It is a common disorder of the circulatory system and affects approximately 10 million people in the United States. To learn more about PAD, watch this video featuring vascular surgeon Jean Starr, MD.

Peripheral artery disease causes 

Peripheral artery disease is usually caused by atherosclerosis, a buildup of fatty deposits in artery walls that leads to restricted blood flow. Atherosclerosis affects the heart and can affect arteries throughout the body.

What are the risk factors for PAD?

An individual is a risk for developing PAD when one or more of these risk factors are present:

  • Smoking
  • Diabetes
  • Obesity (BMI over 30)
  • High blood pressure
  • High cholesterol
  • A family history of PAD, heart disease or stroke
  • High levels of homocysteine, a protein component that helps build and maintain tissue
  • Increasing age, especially after reaching 50 years of age

Smoking and diabetes present the greatest risks of developing peripheral artery disease due to reduced blood flow.

PAD prevention

Peripheral artery disease is frequently detected in people who have coronary artery disease, which is caused by reduced blood flow due to plaque buildup in the arteries. Steps you can take to lower your risk of developing peripheral artery disease include:

  • Quit smoking
  • Maintain a healthy weight
  • Exercise regularly
  • Maintain healthy blood cholesterol levels
  • Control your blood pressure
  • Manage your diabetes

Peripheral artery disease symptoms

People with peripheral artery disease may not experience symptoms during the beginning stages. The most common early symptom is intermittent discomfort in the legs during activity, including:

  • Claudication (pain when walking)
  • Tightness
  • Heaviness
  • Cramping
  • Weakness

With more advanced stages of peripheral artery disease, symptoms may include:

  • Critical limb ischemia (pain in your feet or toes even when you are at rest)
  • Painful sores on your feet or toes (left untreated, these sores can become dead tissue, also known as gangrene)

Many people who have peripheral artery disease have pain in their hips, thighs or calves when engaged in physical activity. The pain often goes away when the exercise stops. This is because the leg muscles used in exercise need more blood flow, and this flow is restricted due to the arteries narrowed by the disorder.

Other symptoms can include:

  • Hair loss on the legs
  • Slow-healing sores on the lower extremities
  • Skin changes on the legs and feet
  • Pain in the toes when at rest or lying flat
  • Paleness of the legs when they are elevated
  • Reddish-blue discoloration of the extremities, and thickened or opaque toenails

Peripheral artery disease often goes undiagnosed. It is important to inform a physician if you have symptoms of peripheral artery disease because the condition can lead to increased risk for heart attack and stroke.

Why choose Ohio State for peripheral artery disease treatment?

Ohio State's vascular surgeons are experienced in the use of many technologies for minimally invasive treatment of peripheral artery disease including cryoplasty, mechanical atherectomy, laser atherectomy and pharmacomechanical thrombolysis. For patients who cannot be treated with traditional methods, our vascular surgeons participate in ongoing clinical trials investigating new treatments for certain cases of peripheral artery disease.

Peripheral artery disease diagnosis 

Physical exam and medical history

Your physician will conduct a physical exam, which includes a pulse test that measures the strength of the pulse in the arteries behind your knees and feet. During this visit, you and your physician will also discuss your medical history and what symptoms you have experienced, when they occur, and how often.

Diagnostic tests

After performing a physical exam and learning about your symptoms and medical history, your doctor may choose to do further testing. Peripheral artery disease can be diagnosed with tests including:

  • Ankle-brachial index (ABI) – A test that determines how well your blood is flowing by comparing the blood pressure in your legs to the blood pressure in your arms
  • CT angiogram (CTA - computed tomography angiogram) – An imaging procedure that uses CT technology to produce cross-sectional, detailed images of blood vessels
  • Ultrasound – A test that uses high-frequency sound waves to evaluate blood flow in a vessel
  • MRA (magnetic resonance angiography) – A noninvasive imaging procedure that uses large magnets, radiofrequencies and a computer to evaluate blood flow through arteries
  • PPG (photoplethysmography) – An examination that uses a very tiny blood pressure cuff around the toe and an infrared light to evaluate blood flow near the surface of the skin
  • PVR (pulse volume recording wavelength analysis) – A technique used to calculate blood volume changes in the legs with a recording device

Peripheral artery disease treatment

Treatment for peripheral artery disease focuses on controlling symptoms and halting the progression of the disease.

PAD Medication

Medications to lower blood sugar, blood pressure and blood cholesterol may be prescribed. Other medications include those that improve blood flow and relax blood vessel walls.

PAD Nonsurgical procedures

Ohio State’s Wexner Medical Center vascular surgeons are experienced in the use of many technologies for minimally invasive treatment of peripheral artery disease including:

  • Angioplasty stenting – A balloon-tipped catheter is inserted into a blocked vessel and inflated, then a small mesh tube is inserted to keep the vessel open
  • Cryoplasty – A combination of cold therapy and angioplasty that reduces the risk of restenosis
  • Mechanical atherectomy – A device is threaded through a catheter to remove plaque in the blocked area
  • Laser atherectomy – Removal of plaque from a blocked artery with the use of a laser
  • Pharmacomechanical Thrombolysis – Dissolving a blood clot with the use of thrombolytic (drug) therapy and a catheter that removes the clot from the affected vessel


Vascular surgery is for patients with vascular disease, such as peripheral artery disease, that cannot be treated by less invasive, nonsurgical treatments. It may involve endovascular procedures in which catheters (thin, flexible tubes) or stents (mesh-like tubes) are inserted to maintain open arteries or veins. Vascular surgery is also used to redirect blood vessels in patients with poor circulation.

For patients who cannot be treated with traditional methods, our vascular surgeons participate in ongoing clinical trials investigating new treatments for certain cases of peripheral artery disease.


Outpatient PAD Rehabilitation 

Outpatient PAD rehabilitation is an outpatient service for patients diagnosed with PAD. The personalized program helps improve the health and wellbeing of people with vascular problems; it includes 36 sessions of exercise training physiologists and registered nurses who will help with medical evaluations, prescribed exercise, risk factor modification and coaching. 

The PAD rehab team works with you and your family to ensure a successful rehabilitation experience. You will be assigned a team member as your case manager who will help track your care and become your resource for any questions or concerns you may have as you progress toward achievement of your program goals. 

Vascular Disease Treatment

Vascular doctors at OSU discovered a clot in Cheryl’s leg that had been there for years. Jean Starr, MD, a vascular surgeon at OSU, explains the symptoms of vascular disease and when to visit your primary care doctor.

What is peripheral artery disease?

Dr. Jean Starr, a vascular surgeon at The Ohio State University Wexner Medical Center, explains what peripheral artery disease is and how it affects approximately 10 million people in the United States.

Why Choose Ohio State for Vascular Care

Patrick Vaccaro, MD, explains how Ohio State physicians have the training and background to treat a range of problems, including critical ischemia, aneurysms and thoracic outlet syndrome.

Blood Clots in the Legs: Symptoms, Diagnosis and Treatment

Peripheral Artery Disease Treatment at Ohio State

Patrick Vaccaro, MD, explains the advancements in treatment of PAD, with many patients benefiting from simpler outpatient procedures. 

Our Providers

Share this Page