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Peripheral Arterial Disease

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Peripheral arterial disease describes disorders of the circulatory system (including the arteries and veins) outside of the brain and heart. One of these conditions is known as peripheral arterial disease (PAD) which is a narrowing of the arteries in the legs or arms.

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What is Peripheral Arterial Disease (PAD)? | Q&A

Vascular Surgeon Mahmoud Malas discusses symptoms, diagnosis and treatment of peripheral arterial disease.

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Causes of Peripheral Artery Disease

The most common cause of PAD is atherosclerosis, or buildup of plaque in the arterial walls. Plaque -- composed of cholesterol-rich fatty deposits, collagen and other proteins, as well as excess smooth muscle cells -- gradually accumulates causing the thickening of the arterial walls. This thickening narrows the vascular channels and impedes blood flow.
Age, smoking, and diabetes are the most important risk factors for developing PAD. Obesity, a sedentary lifestyle, high cholesterol levels and high blood pressure also contribute to atherosclerosis.

Risks of PAD

PAD typically occurs after the age of 50, although it can affect some male smokers as early as age 20. Diabetes and smoking greatly increase the risk of PAD. PAD shares the same risk factors as coronary artery disease, and these conditions often occur together. The disease may worsen if left untreated, in some cases even leading to tissue death (gangrene).

Peripheral vascular disease is most common after the age of 50, although one form can affect some male smokers as early as age 20. Diabetes greatly increases the risk of peripheral vascular disease, especially in women.

The disease may worsen if left untreated, in some cases even leading to tissue death (gangrene). Peripheral vascular disease shares the same risk factors as the more dangerous coronary artery disease, and the diseases often occur together.

When to Call Your Doctor

When to Call Your Doctor
Make an appointment with your doctor if you repeatedly develop muscle pain or discomfort in the legs with walking. Your doctor may order a simple test known as the ankle-brachial index (ABI) to determine whether or not you have PAD.

Fewer than half of people with PAD experience symptoms. Most frequently, those symptoms include:

  • Muscle pain in the calves or thighs of one or both legs that occurs when walking, especially fast or uphill. Pain subsides with rest. It may also occur in the fingers, arms, buttocks, lower back or the arch of the foot.
  • Impotence (erectile dysfunction).
  • When the disease is severe, pain occurs while the person is at rest which is called critical limb ischemia. Symptoms may include:
    • leg or foot pain at rest that worsens at night
    • discolored or blue toes
    • cold or numb feet
    • sores on the feet or legs that do not heal

These symptoms may be due to aortoiliac disease (pelvic vessels) or femoral popliteal disease (thighs and leg vessels). The vascular surgeons at Johns Hopkins are experienced in diagnosing and treating these regions of vascular disease with both catheter-based and open surgical bypasses. Catheter-based treatment options may include angioplasty and stenting.

Atherosclerosis is the most common cause of PAD. Age, smoking, and diabetes are the most important risk factors for developing PAD. Obesity, a sedentary lifestyle, high cholesterol levels and high blood pressure also contribute to atherosclerosis.


Some risk factors, such as age and family history, cannot be altered. But there are factors you can control to reduce your risk of developing PAD:

  • Don’t smoke.
  • Exercise regularly.
  • Eat a diet low in saturated fat, cholesterol and salt.
  • Have your cholesterol, blood sugar, and blood pressure checked.
  • Lose weight if you are overweight


Johns Hopkins has earned an international reputation for excellence in patient care and clinical research in the area of vascular disease. We specialize in the diagnosis and management of carotid artery disease, aortic aneurysms and poor circulation to the brain, kidneys, and legs. We provide comprehensive services for all types of vascular conditions, from the less invasive technology of catheter-based intervention to traditional surgery.

If you wish to be evaluated for PAD, a Johns Hopkins Heart and Vascular physician will first examine you at our Outpatient Center or one of our conveniently located satellite facilities. If necessary, you may be asked to undergo one or more non-invasive tests.

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How is Peripheral Arterial Disease (PAD) treated? | Q&A

Vascular Surgeon Mahmoud Malas discusses treatment options for peripheral arterial disease, and explains what to expect during recovery for surgical procedures.

Play Now | Transcript

The Heart and Vascular physician sees patients with all disease processes affecting the circulatory system (arteries, veins, and lymphatics). We also work with experts in the areas of endovascular therapy, vascular surgery, wound care, preventive cardiology, and exercise rehabilitation. A multidisciplinary team approach is utilized to provide expedient and expert care in the management of simple as well as complex vascular disorders.

Once you have been evaluated by a physician, your doctor will work with you on a treatment plan that may include the following options:

  • Exercise is the most consistently effective treatment for PAD, leading to substantial increases in the distances walked without painful symptoms. Each day, take a walk and continue until leg pain develops. Rest for a short time to let the pain subside, then continue walking. Gradually, the distance that can be traveled painlessly will increase. A supervised exercise program is ideal, such as that offered by our Clinical Exercise Center.
  • Practice good foot care and check your feet every day. Poor circulation due to PAD slows the healing of sores. Spotting problems early may help to prevent minor foot problems from becoming major infections.
  • Medication is critical to reduce cardiovascular risk. Daily aspirin, or an alternative such as clopidogrel, is prescribed in patients with PAD for the prevention of heart attack and stroke. Cholesterol-lowering medicines such as statins are important for decreasing cardiovascular risk and may also increase walking distance. High blood pressure should be controlled with medicine such as ACE inhibitors. People with diabetes must maintain scrupulous control over their blood sugar levels. Beta-blockers may be prescribed in patients with PAD to decrease the risk of heart attack around the time of surgery.
  • Angioplasty may be performed if the blood vessels are clogged with plaque. Using local anesthesia, the doctor will insert a catheter - a long, narrow tube - with a deflated balloon at its tip into the narrowed part of the artery. The balloon is inflated, compressing the plaque and enlarging the inner diameter of the blood vessel so blood can flow more easily.
  • Bypass surgery to re-route blood flow may be necessary in severe cases if angioplasty is unsuccessful. A vascular surgeon will use one of your veins or an artificial vein to bypass the blockage and thus provide a blood supply to the lower leg again.

To make an appointment to see a Vascular Medicine physician, please call the Cardiovascular Access Line at 443-997-0270.

To make an appointment to see a Vascular surgeon, please call Vascular Surgery and Endovascular Therapy at 410-955-5165.


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Avoiding Leg Amputations Due to Peripheral Arterial Disease | Q&A

Johns Hopkins Medicine Vascular Surgeon Dr. Thomas Reifsnyder discusses symptoms, diagnosis and treatment of severe peripheral arterial disease (PAD). He also shares insight on how to avoid limb amputations, including leg and foot removal.

Play Now | Transcript


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