Symptoms of Peripheral Artery Disease

Peripheral Artery Disease (PAD) is a chronic condition caused by arteriosclerosis that results in insufficient blood supply to the limbs. Its early symptoms may be subtle, but as the disease progresses, it can significantly impact daily life. Understanding the characteristic symptoms aids in early diagnosis and treatment, preventing severe complications. This article will detail the symptom presentation at different stages, progression patterns, and when immediate medical attention is necessary.

The symptoms of this disease are mostly related to circulatory disturbances, most commonly in the lower limbs. Initially, symptoms may be mild discomfort, but if not properly managed, it can lead to tissue necrosis or amputation. Notably, about 40% of patients have no obvious symptoms in the early stages, so high-risk groups (such as those with hypertension or diabetes) should undergo regular vascular examinations. The following sections describe the features and changes of symptoms at various stages.

Early Symptoms and Signs

Early symptoms of PAD are often mistaken for general fatigue or exercise discomfort and are easily overlooked. The main signs include:

Intermittent Claudication: Soreness or heaviness in the calf or thigh muscles during walking, relieved by rest, with symptoms recurring upon walking again.
Muscle fatigue in the legs: Even mild activity causes rapid fatigue in the calf or gluteal muscles, much earlier than in healthy peers of the same age.
Limb coldness: The affected limb (usually the lower limb) often feels abnormally cold, even in warm environments.

Some patients may exhibit atypical signs, such as pallor of the skin on toes or soles, or reduced hair growth. These signs may relate to local blood supply deficiency but usually require medical examination for confirmation.

Other Early Warning Signs

In addition to the main symptoms, the following phenomena should raise alertness:
- Weak or absent palpable arterial pulsations
- Prolonged capillary refill time in the foot (e.g., color reappearing after pressure exceeds 5 seconds)
- Reduced oxygen saturation in veins causing purple discoloration of the limb

Common Symptoms

When arterial blockage exceeds 50%, symptoms become more prominent and frequent. Main symptoms include:

: Immediate cramping in the calf, thigh, or gluteal muscles during walking or climbing stairs, requiring cessation of activity for relief.

Skin changes: The skin on the foot or leg may appear pale or bluish-gray, dry, and less elastic, with significantly slowed hair and nail growth.

Temperature differences: The affected limb may be more than 3°C cooler than the healthy limb, with possible loss of normal tactile sensation.

About 30% of patients experience “rest pain at night,” where even without activity, the toes or soles have a burning pain that severely affects sleep quality. These symptoms usually indicate critical arterial occlusion requiring urgent medical evaluation.

Associated Systemic Symptoms

Although the main symptoms are in the lower limbs, PAD often coexists with systemic vascular issues. About 40% of patients may develop coronary artery disease or stroke, so attention should be paid to the following related symptoms:

Angina or irregular heartbeat

Dizziness or blurred vision (possibly due to cerebral ischemia)

Blood pressure discrepancy (difference of more than 20 mmHg between arms)

Disease Progression and Symptom Changes

As the condition worsens, symptoms tend to escalate in a stepwise manner. The first stage is characterized by activity-induced pain, progressing to pain at rest in the second stage. The third stage may involve ischemic tissue necrosis, with specific changes as follows:

In the mid-stage, patients may observe:

Prolonged pain duration: Pain that initially subsides after 10 minutes of rest may extend to over 30 minutes.

Increased pain severity: From mild discomfort to severe pain, even affecting sleep at night.

Skin tissue changes: Unexplained ulcers on toes or heels, with surrounding skin appearing dark purple or black.

Severity of Late-Stage Symptoms

When arterial blockage exceeds 70%, irreversible tissue damage may occur. Symptoms at this stage include:

Painless ulcers: Nerve damage causes decreased pain sensation, but tissues are severely ischemic.

Hyperpigmentation: Black patches resembling psoriasis on toes or soles, accompanied by tissue necrosis.

Absent pulses: Weak or absent dorsalis pedis or popliteal artery pulsations upon palpation.

This stage may also involve systemic metabolic abnormalities, such as elevated blood lactate levels and abnormal C-reactive protein indices, requiring immediate vascular imaging examinations.

When to Seek Medical Attention

The following situations require immediate medical assistance:

Unexplained limb coldness lasting more than 48 hours

Foot ulcers enlarging by more than 1 cm within two weeks

Blood oxygen saturation (SpO2) difference exceeding 15% between limbs

Foot ulcers with no pain (may indicate nerve damage combined with arterial occlusion)

It is recommended to undergo ankle-brachial index (ABI) screening every 6 months, especially for those over 60, smokers, or diabetics. If any of the following signs appear, it should be considered an emergency:

Black patches resembling psoriasis on toes or soles

Skin temperature of the limb more than 10°C lower than the contralateral limb

Swelling and redness around ulcers

Doctors may further arrange Doppler ultrasound or computed tomographic angiography (CTA) to assess the degree of arterial stenosis. Early diagnosis allows for medication or surgical intervention to delay disease progression and prevent irreversible tissue damage.

Frequently Asked Questions
Does regular exercise worsen symptoms of peripheral artery disease?
Moderate exercise can actually improve blood circulation in the lower limbs, but in the early stages, activity may trigger intermittent claudication (such as calf pain during walking). It is recommended to perform regular exercise under medical guidance, such as walking training, to enhance muscle utilization of blood and gradually alleviate symptoms rather than worsen them. Exercise should avoid overexertion and monitor body response closely.
How do symptoms of peripheral artery disease differ from varicose veins?
Typical symptoms of PAD include leg pain during exercise (such as calf soreness after walking), whereas varicose veins mainly present as leg swelling, visible dilated blood vessels, or heaviness. The underlying causes differ: PAD results from arterial blockage leading to insufficient blood supply, while varicose veins involve venous reflux. If symptoms are confusing, vascular ultrasound or Doppler examination can help clarify the diagnosis.
How does diet influence the management of peripheral artery disease symptoms?
A low-salt, low-fat, high-fiber diet can reduce blood pressure and cholesterol, slowing atherosclerosis progression. It is advisable to increase intake of omega-3-rich foods (such as fatty fish) and antioxidants (such as berries and leafy greens), and control blood sugar and lipids. Avoid high-sugar and trans fats to reduce vascular inflammation.
Besides medication, what non-invasive treatments can improve arterial blockage?
Vasodilators or antiplatelet drugs can control symptoms, but physical therapies like intermittent pneumatic compression can temporarily improve circulation. Additionally, quitting smoking, controlling hypertension, and managing hyperlipidemia are crucial. Severe blockages may require angioplasty or surgery, which should be decided by a physician after evaluation.
Why is early diagnosis of peripheral artery disease crucial for prognosis?
Early detection allows for medication and lifestyle adjustments to slow disease progression, preventing progression to limb ischemia or necrosis. Untreated, patients risk worsening arterial blockage, increasing the likelihood of amputation and developing coronary or cerebrovascular disease. Those with intermittent claudication or limb coldness should undergo ankle-brachial index (ABI) or vascular imaging examinations promptly for early intervention.