Peripheral Arterial Disease (PAD) is a circulatory problem in which narrowed arteries reduce blood flow to the limbs. This not only affects the legs but also the heart and brain.[1]

Peripheral arterial disease (PAD) sometimes known as peripheral vascular disease (PVD) occurs when there is a narrowing or occlusion of the peripheral arteries resulting in reduced blood flow to the leg [2].

The narrowing of the lumen of the artery is usually caused by a build-up of plaque along the artery wall. If this plaque becomes too thick or breaks away, it can result in limb ischaemia. This plaque build-up can also affect the flow of blood through the arteries, which can lead to a thrombosis[3].

Peripheral arterial disease occurs when there is a narrowing or occlusion of the peripheral arteries resulting in reduced blood flow to the leg.

The onset of PAD is often asymptomatic, and, if undiagnosed, can lead to amputations and early death. In England, every hour someone over the age of 50 has a partial foot amputation; and every two hours someone loses their whole leg as a result of PAD. Of the 11,500 lower limb amputations carried out in England in 2016, 80% could have been prevented if the disease had been diagnosed sooner [4].

PAD Symptoms

Not everyone with PAD has symptoms and some symptoms will be vague, such as poor mobility or loss of strength. More obvious symptoms are:

  • leg pain when walking,
  • wounds that do not heal,
  • coldness in a leg or foot, or,
  • in men, problems getting or keeping an erection.

Risk factors for PAD

The principal risk factor for PAD in people over 50 years is smoking. Studies have shown that 95% of people presenting with PAD have a history of smoking [5].

Other risk factors include:

  • Diabetes
  • High blood pressure
  • High cholesterol
  • History of heart disease
  • Obesity

The risk for PAD also increases with age.

What are the burdens of Peripheral Arterial Disease?

Patients with PAD are at high risk of lower limb amputation. Most lower limb amputations are a result of foot ulcers, half of which are associated with PAD[6].

Patients with PAD are also at risk of leg ulcers, which may be slow to heal and have a negative impact on quality of life, as well as putting a patient at risk of amputation

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[1] Steg PG, Bhatt DL, Wilson PW, et al (2007) One-year cardiovascular event rates in outpatients with atherothrombosis. JAMA 297(11): 1197–206

[2] National Institute for Health and Care Excellence (2015) Clinical knowledge summaries: Peripheral arterial disease. NICE, London. Available online: https://

[3] Jaffery Z, Thornton SN, White CJ (2011) Acute limb ischemia. Am J Med Sci 342(3): 226–34

[4] All Party Parliamentary Group on Vascular Disease (2019) Saving Limbs, Saving Lives. A call to action to reduce inequalities in lower limb amputation rates. Available online:

[5] Powell J, Davies A (2010) Peripheral arterial disease. In: Warrell DA, Cox TM, Firth JD, Ogg GS, eds. Oxford textbook of medicine. Oxford University Press, Oxford: 2959–66

[6] Ahmad N, Thomas GN, Gill P, et al (2016) The prevalence of major lower limb amputation in the diabetic and nondiabetic population of England 2003–2013. Diabetes Vasc Dis Res 13(5): 348–53