Peripheral Artery Disease (PAD) is a chronic condition characterized by narrowed peripheral arteries, leading to impaired blood flow, especially in the limbs.
It is commonly associated with atherosclerosis—a progressive process involving endothelial dysfunction and lipid accumulation in arterial walls. While PAD primarily affects the lower extremities, its systemic nature marks it as a warning sign for widespread vascular compromise.
Pathophysiology: From Endothelial Injury to Critical Ischemia
The underlying mechanism of PAD is largely driven by atherosclerotic plaque formation, which narrows the arterial lumen and limits oxygen delivery to distal tissues. Initial endothelial injury often caused by smoking, diabetes mellitus, or hypertension, triggers inflammatory cascades, attracting monocytes and leading to foam cell formation. As plaques mature, arterial compliance is reduced, and perfusion becomes inadequate, particularly during exertion.
Professor Michael Criqui, a leading expert in cardiovascular epidemiology at the University of California San Diego, emphasizes that "PAD is not just a localized problem; it’s a systemic marker of elevated cardiovascular risk.”
Clinical Manifestations: Beyond the Typical Intermittent Claudication
While intermittent claudication—pain or cramping in the legs during activity is a hallmark symptom, many individuals with PAD remain asymptomatic or present with atypical signs. Advanced stages may progress to critical limb ischemia, characterized by non-healing wounds or rest pain.
Non-classical symptoms such as cold extremities, reduced hair growth on the legs, and diminished distal pulses require heightened clinical suspicion, especially in diabetic patients, where neuropathy can obscure classical pain signals.
Diagnostic Tools: Moving Beyond the Ankle-Brachial Index
The Ankle-Brachial Index (ABI) remains the gold standard for initial screening, offering a non-invasive, cost-effective method to evaluate arterial perfusion. However, new advancements are shaping early detection. Modern imaging techniques like Duplex Ultrasound, Magnetic Resonance Angiography (MRA), and CT Angiography offer detailed insights into lesion location and severity. Recently, near-infrared spectroscopy and tissue oxygenation monitors have shown promise in assessing functional perfusion and guiding treatment response in real time.
Risk Stratification and Associated Morbidities
PAD is intricately linked with systemic cardiovascular events. Patients with PAD are at a threefold increased risk for myocardial infarction. Co-existing comorbidities such as chronic kidney dysfunction and diabetes further complicate management. Risk stratification must consider not only limb symptoms but also systemic cardiovascular burden. According to a 2024 review in Circulation Research, integrating PAD into routine cardiovascular risk assessments can significantly alter preventive strategies.
Management Approaches: From Medical Therapy to Endovascular Solutions
- Antiplatelet agents (e.g., clopidogrel or aspirin)
- Statins to stabilize plaques
- Supervised exercise therapy
- Glycemic and blood pressure control
Peripheral Artery Disease extends beyond limb-specific symptoms—it is a harbinger of systemic vascular deterioration. Prompt diagnosis, aggressive risk factor modification, and tailored treatment pathways are essential to mitigate long-term complications. As new diagnostic modalities and therapies evolve, early identification remains the cornerstone of preventing both limb and life-threatening outcomes.
