• Plaque buildup in the arteries(called atherosclerosis) that carry blood to your head, organs, and limbs.
  • Plaque is made up of fat, cholesterol, calcium, fibrous tissue that can harden and narrow the arteries.
  • Limits the flow of oxygen-rich blood from your heart to your hands, legs, head, kidneys, and stomach.
  • Here we will here focus on P.A.D. that affects blood flow to the hands.
  • Less common than Lower Limb Disease due to the arms’ closer proximity to the heart, and the fact that most patients are asymptomatic.


  • Smoking.
  • Diabetes.
  • High amounts of certain fats and cholesterol in the blood.
  • Tobacco usage in any form.
  • High blood pressure.
  • Inherent blood clotting issues.
  • Old age.
  • Obesity.
  • Thoracic Outlet syndrome.
  • Raynauds syndrome.
  • Idiopathic(unknown).
  • Eventually, a section of plaque can rupture (break open), causing a blood clot to form at the site.


  • Acute- Sudden block of the blood vessels causing an immediate threat to the hand.
  • High risk of amputation.
  • Needs urgent treatment.
  • Chronic- Gradual decrease in blood flow.
  • Needs treatment of the underlying cause.


P.A.D. increases your risk of coronary heart disease, heart attack, stroke, and transient ischemic attack (“mini-stroke”).


  • Weak or absent pulses in the hands.
  • Intermittent Claudication symptoms when using the arms and forearms for work may include pain, numbness, aching, or heaviness in the muscles. Symptoms also may include cramping in the affected side.
  • Pain in the fingertips even at rest.
  • Sores or wounds on the fingers that heal slowly, poorly, or not at all.
  • Gangrene (tissue death)- black color change of skin and tissue.
  • Infected wounds.
  • A pale or bluish color to the skin.
  • A lower temperature in one hand compared to the other hand.


  • Doppler Ultrasound.
  • Stress position tests.
  • X-rays of the neck to see bony abnormalities.
  • Computerized Tomographic Angiogram (CT Scan).
  • Magnetic Resonance Angiogram (MRI Scan)
  • Angiogram


  • Treatment is based on your signs and symptoms, risk factors, and the results of physical exams and tests.
  • Overall goals- improving symptoms and quality of life, reducing symptoms of claudication, reducing infection, healing wounds, reducing the risk of heart attack, kidney failure, and stroke.
  • The target of treatment in Claudicants- improve pain-free period.
  • The target of treatment in individuals with wounds/gangrene- remove dead tissue, heal the wound and preserve healthy tissue.

Healthy Lifestyle Changes

  • Physical activity
  • Quitting smoking
  • Heart-healthy eating


Bypass Grafting/Embolectomy Surgery- open surgery.