Peripheral arterial disease (PAD) the shop-window disease

Shop-window disease gets its name from the fact that people can only walk short distances and then have to stop and rest, much like when window-shopping. But its a serious condition medically known as peripheral arterial disease (PAD). PAD is also known as smokers leg.

It means the arteries supplying the limbs are narrowing progressively. In the legs this is due to atherosclerotic changes in the pelvic or leg arteries, which reduce blood flow to the legs. The tissues no longer get enough oxygen and nutrients, which can cause pain. This leads to the symptoms described above. In the worst case, tissue can die and amputation may be necessary.

About 50 percent of PAD cases are found in the femoral (thigh) artery. The pulse in the knee crease and at the foot may no longer be palpable. Pain mainly occurs in the calf.
In around 30 percent of cases the narrowing is located in the pelvic arteries. The pulse in the groin is then also not palpable. Pain can occur in the buttocks and thigh. If the narrowing is a little higher in the abdominal aorta before the branching to the pelvic arteries this is called Leriche syndrome. Here, too, the legs are not properly supplied with blood. There can also be bladder and rectal problems, and in men erectile problems up to impotence.
Twenty percent of PAD cases occur in the arteries of the lower leg. In this case the pulse at the foot is no longer palpable and the pain affects the sole of the foot.
Less commonly, the arteries of the arms are affected by PAD.

As with all atherosclerotic changes in the body (they usually affect more than one site), risk factors that promote PAD include high blood pressure, smoking, diabetes and high blood lipids. An unhealthy diet, lack of exercise and overweight also pave the way for atherosclerosis.

That is why having PAD is also considered a risk factor for other conditions such as heart attack, stroke or sudden cardiac death.

The development of PAD often goes unnoticed at first. Symptoms only appear after the arteries are narrowed to a certain degree.

Peripheral arterial disease can therefore be divided into different stages:

Stage I: The narrowings are still minimal there are no or only rare symptoms such as leg pain. In this stage PAD is often found by chance.

Stage II: Symptoms now occur with activity. Depending on where the narrowing is, the pain mainly affects the calves, less often the thighs or the buttocks. Walking uphill, walking faster or walking with extra weight such as a shopping bag becomes increasingly difficult. The pain disappears after standing still for a few minutes. People often use the pause to look at shop windows, which is why this is called shop-window disease. Longer distances can no longer be walked pain-free. Stage II is subdivided by walking distance into IIa with a walking distance of more than 200 m and IIb with a walking distance under 200 m.

Stage III: Pain is now present even at rest especially when lying down. The feet and toes are particularly painful due to reduced oxygen and nutrient supply.

Stage IV: At this stage the tissue is damaged. Small injuries heal poorly. Ulcers and infections can develop. Tissue can die in the worst case an amputation may be necessary.

How is PAD detected?

If the doctor suspects PAD, the ankle-brachial index (ABI) is measured. For this he measures blood pressure with a cuff and a Doppler ultrasound probe on the arm and just above the ankle. The systolic pressure at the ankle is then divided by the systolic pressure at the upper arm. If the vessels are healthy, the values are about equal and the ABI is around 1.0. PAD is present if the value is 0.9 or less. This is then further investigated with an ultrasound scan. If that is not sufficient or surgery is planned, further tests such as MRI, angiography or catheter-based imaging can be done.

What can be done?

Changing your lifestyle is essential to slow the progression of PAD. Walking is especially important here, because walking exercises train the blood vessels.

Medication may also be needed in some cases. In severe cases there are invasive options such as angioplasty with a catheter or placing a stent. In vascular surgery the vessel can be reopened or a bypass can be performed.

Of course the best approach is to prevent it from getting this far by adopting a healthy lifestyle and staying active to avoid developing or worsening the disease.

Sources:

This article comes from BloodPressureDB – the leading app since 2011 that helps hundreds of thousands of people monitor their blood pressure every day. Our content is based on carefully researched, evidence-based information and is continuously updated (as of 11/2025).

Author Sabine Croci is a certified medical assistant with many years of experience in internal medicine and cardiology practices as well as in outpatient care. Since 2015 she has led the editorial team at BloodPressureDB. With additional qualifications as a paramedic, first responder, and training in various therapy and emergency areas, she provides well-founded, practical, and reliably reviewed information.

Peripheral arterial disease (PAD) the shop-window disease

How is PAD detected?

What can be done?

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