Peripheral Artery Disease Can Increase the Risk of Amputation

Peripheral artery disease (PAD) is associated with an increased risk of mortality, cardiovascular morbidity, and major amputation.

What is PAD?

Healthy arteries in the limbs, also known as peripheral arteries, are smooth and free of any blockages, allowing the blood to flow freely and supply the arms and legs with oxygen, glucose, and other nutrients. Over time, peripheral arteries build up plaque, a sticky substance made up of fat and cholesterol. Plaque can narrow the passageway within the arteries, cause them to stiffen leading to peripheral artery disease.

A moderate blockage in one of the arteries in a major leg muscle can cause pain when walking. This type of intermittent pain is referred to as claudication by providers. The pain itself is not limb-threatening but can be a sign that lifestyle changes and a doctor’s visit are in order.

As PAD becomes more severe, it can cause pain at rest, especially at night. Sores that won’t heal may appear on the feet. Left untreated, PAD can lead to amputation of the toes or the leg. An urgent referral to a vascular surgeon is required to prevent limb loss in this situation.

Image courtesy of Society for Vascular Surgery

Risk Factors

There are several potential risk factors of PAD that include:

  • Age
  • Gender-males are more prone to the condition than females
  • Hypertension (high blood pressure)
  • Diabetes
  • Smoking
  • High cholesterol
  • Obesity
  • Lack of exercise
  • Family history of vascular problems
Courtesy of Society for Vascular Surgery


  • Painful muscle cramping in the hips, thighs, or calves when walking, climbing stairs, or exercising
  • Leg pain that does not go away when you stop exercising
  • Foot or toe wounds that won't heal or heal very slowly
  • Gangrene, or dead tissue
  • A marked decrease in the temperature of your lower leg or foot particularly compared to the other leg or to the rest of your body
  • Poor nail growth on the toes or hair growth on the legs
  • Erectile dysfunction, especially in men with diabetes
Courtesy of


Physical examinations for PAD will likely begin with checking for weak pulses in the legs. Exams can include the following:

Ankle-brachial index (ABI)

Ankle-brachial index (ABI) is a painless test that compares the blood pressure in the feet to the blood pressure in the arms to determine how well the blood is flowing.

Doppler and Ultrasound (Duplex) imaging

Doppler and Ultrasound (Duplex) imaging is a non-invasive method that visualizes the artery with sound waves and measures the blood flow in an artery to indicate the presence of a blockage.

Computed Tomographic Angiography (CT)

Computed Tomographic Angiography (CT) is a non-invasive test that can show the arteries in the abdomen, pelvis and legs.

Magnetic Resonance Angiography (MRA)

Magnetic Resonance Angiography (MRA) is a non-invasive test that gives information similar to that of a CT without using X-rays.


During an angiogram, also called an arteriogram, a contrast agent is injected into the artery and X-rays are taken to show blood flow, arteries in the legs and to pinpoint any blockages that may be present.


Treatment options depend on the severity of the condition. They can include lifestyle changes and medications. Options may also include procedures such as:



Angioplasty is when a balloon or stent is used to open an artery and keep it open.


Bypass Surgery

Bypass surgery moves a blood vessel from another part of the body to the area around the block to create a graft, allowing the blood to flow around the blocked artery much like a detour.

Courtesy of Society for Vascular Surgery