Leg Artery Disease

Basic Facts:

  • Leg artery disease, also called peripheral artery disease (PAD), refers to a partial or complete blockage of the circulation to the legs and feet.
  • The risk factors for PAD include diabetes mellitus, smoking, high blood pressure, high blood cholesterol, male gender, advanced age and a sedentary lifestyle.
  • Discomfort in the muscle group of the leg while walking, a phenomenon called intermittent claudication, is a common symptoms of leg artery disease.
  • Leg artery disease is a partial or complete blockage of circulation through the arteries of the leg. This compromised blood flow can cause problems in the hip, buttock, thigh, knee, shin or upper foot. Atherosclerosis, or the hardening of the arteries, is considered the primary cause.

What are the symptoms?

Many cases of leg artery disease are ‘silent,’ meaning that the person with the disease does not yet experience any noticeable symptoms (asymptomatic). Asymptomatic peripheral artery disease (PAD), however, is a serious issue. Even though the patient feels well, he or she is at significantly increased risk of suffering a heart attack or stroke.

Discomfort in the legs is a common first symptom of leg artery disease. Called intermittent claudication, or IC, the discomfort usually occurs in large muscles in one or both legs during exercise, such as walking. Not every person with PAD experience leg pain. Some people may feel a tightness, heaviness, cramping or weakness in the leg.

When people experience intermittent claudication, the discomfort tents to occur consistently, typically each time a person walks a certain distance, and fades away within a few minutes after a person stops to rest. As leg artery disease progresses, leg pain may occur at shorter and shorter walking distances.

Eventually a person may feel pain the arch of the foot, even at rest, when reduced blood flow prevents tissues from getting enough oxygen, a condition called critical limb ischemia. Many people with advanced leg artery disease report pain in the arches of their feet or in their toes while lying down.

In severe cases of leg artery disease, people may develop painful skin ulcers on their toes or feet.

Causes and risk factors

As people age, the normal flow of blood through the legs and feet can be affected by the buildup of plaque inside the arteries. Over time, these plaques continue to grow on arterial walls as cholesterol circulates in the blood, and as the plaques enlarge the arteries become narrow and stiffened. This process is called atherosclerosis, commonly known as ‘hardening of the arteries’ because the plaque buildup thickens the walls of the arteries, narrowing the space through which blood flows. When this narrowing occurs in leg arteries, the circulation of blood through the leg is compromised. Poor circulation in turn can cause ischemia, or a decrease in blood flow that causes insufficient oxygen levels.

Atherosclerosis may also cause coronary heart disease (CHD) when plaque causes blockages in the arteries that bring blood to the heart muscle. Carotid artery disease, or plaque buildup that interferes with the flow of blood to the brain, is also caused by atherosclerosis. These conditions are serious because CHD can cause heart attacks, and carotid artery disease can result in stroke.

Physicians estimate that 30 to 40 percent of people with CHD or carotid artery disease also suffer from leg artery disease or another form of PAD, and that 50 to 60 percent of patients with PAD will develop either CHD or carotid artery disease.

A person’s risk of developing leg artery disease increases with age, with people over age 50 being at greatest risk of developing the disease. more men that women tend to develop leg artery disease.

Other factors that contribute to the risk of developing leg artery disease are:

  • Smoking;
  • Hypertension, or high blood pressure;
  • Diabetes mellitus;
  • High levels of cholesterol or triglycerides in the blood;
  • Being more than 30 percent over one’s ideal weight; and
  • Having high levels of an amino acid called homocysteine in the blood.


Physicians can diagnose leg artery disease after performing a careful medical history and physical examination, which includes measuring the blood pressure in the legs, testing blood cholesterol levels and listening to a person describe symptoms. Physicians also assess the strength of the pulse in arteries behind the knee and on the foot. Weak or absent pulses in those areas may indicate leg artery disease.

To test the blood pressure in a person’s legs, physicians measure the ankle/brachial index, or ABI. This painless test combines a traditional blood-pressure device and Doppler ultrasound to compare the blood pressure in a person’s arms to the blood pressure in the person’s legs.

To provide more information about the extent of leg artery disease, doctors use other tests, including:

  • Duplex Ultrasound;
  • Pulse Volume Recording;
  • Magnetic Resonance Imaging; and/or
  • Arteriography.