How Is Peripheral Arterial Disease Treated?

Goals of Treatment

The overall goals for treating peripheral arterial disease (PAD) are to reduce symptoms, improve quality of life, and prevent complications. Treatment is based on symptoms, risk factors, physical exam results, and diagnostic tests.

Specific Types of Treatment

Specific treatments for PAD include lifestyle changes, medicines, and surgery or special procedures.

Lifestyle Changes

Treatment often includes making long-lasting lifestyle changes, such as:

• Quitting smoking. Smoking increases the risk of developing PAD three to five times. The risk for coronary artery disease (CAD) decreases rapidly if the smoker quits. The risk for CAD decreases 40 percent within 5 years of stopping smoking.
• Lowering blood pressure. Lowering blood pressure can help to avoid the risk of stroke, heart attack, congestive heart failure, and kidney disease.
• Lowering high cholesterol levels. Lowering cholesterol levels can delay or even reverse the buildup of plaque in the arteries.
• Lowering blood glucose levels if you have diabetes. A hemoglobin A1C test—a test that gives an estimate of how well blood sugar has been controlled over the past 3 months—may be performed.

Talk with your doctor about participating in a supervised exercise therapy program. Follow a low-saturated fat, low-cholesterol diet, and eat foods with less salt, total fat, and saturated fat. Eat more fruits, vegetables, and low-fat dairy products. If you are overweight or obese, work with your doctor to develop a reasonable weight-loss plan. If you are diabetic or at risk for critical limb ischemia, have your feet examined regularly.

Medicines

Medicines may be prescribed to:

• Lower high cholesterol levels and high blood pressure
• Thin the blood to prevent clots from forming due to low blood flow
• Dissolve blood clots
• Help improve pain in the legs that is the result of walking or climbing stairs (claudication)

Some medicines lower the level of low density lipoprotein (LDL) cholesterol. LDL is the "bad" cholesterol. The higher the LDL level in the blood, the greater the chance of heart disease. Medicines may include statins, such as lovastatin, simvastatin, pravastatin, fluvastatin, and atorvastatin. Other medicines may include ezetimibe, gemfibrozil, and certain binding agents.

Blood pressure should be lowered if it is too high. Treatment should aim for a blood pressure lower than 130/80 mmHg. Many medicines are available to lower blood pressure, such as angiotensin-converting enzyme (ACE) inhibitors, angiotensin receptor blockers (ARBs), beta-blockers, diuretics ("water pills"), and calcium channel blockers.

Anticoagulants or blood thinners may be prescribed to prevent clots in the arteries. Thrombolytic therapy involves clot-dissolving drugs inserted into an artery to break up a blood clot. To stop platelets from clumping together, antiplatelet drugs such as clopidogrel (Plavix^®) and aspirin may be prescribed. To help increase distances walked without pain and help improve claudication, pentoxifylline (Trental^®) or cilostazol (Pletal^®) may be prescribed.

Surgeries or Special Procedures

Surgery may be necessary if blood flow in a limb is completely or almost completely blocked. In bypass grafting surgery, the doctor uses a blood vessel from another part of your body or a tube made of synthetic (man-made) material to make a graft. This graft bypasses the blockage in the artery, allowing blood to flow around it. Surgery does not cure PAD, but it may increase blood flow to the limb.

Angioplasty (AN-jee-oh-plas-tee) may be performed to restore blood flow through a narrowed or blocked artery. During the procedure, a thin tube (catheter) is inserted into a blocked artery and a small balloon on the tip of the catheter is inflated. When the balloon is inflated, plaque is pushed against the artery walls. This causes the artery to widen, restoring blood flow. A stent, a tiny mesh tube that looks like a small spring, is now used in most angioplasties. Some stents are coated with medicine to help prevent the artery from closing again.

Other Types of Treatment

Cell and gene therapies are currently being researched, but are not yet available outside of clinical trials. For further information about clinical trials, see the Links to Other Information About Peripheral Arterial Disease section.