Treatment for PAD
The goals of PAD treatment are to reduce symptoms and prevent the condition from worsening or progressing. Treatment usually includes lifestyle changes, regular exercise, and medications. In severe cases that do not respond to conservative PAD treatment, surgery may be necessary.
The first line of attack in treating PAD, as with heart disease, is diet and exercise, and sometimes medicine. Don't smoke, maintain a healthy weight, and lower cholesterol, blood pressure, and blood sugar levelsif necessary.
There are also medications that can help, and surgeries that may restore blood flow to extremities. "We can't cure PAD but we can treat late complications," says Dr. Desvigne-Nickens. "Treatments are evolving, with gene therapies, catheter techniques to remove clogs and surgery and grafts to bypass clots."
Your health care provider will determine the best treatment for you, based on your medical history and health status. Early treatment of PAD can preserve or restore your mobility, decrease your risk for heart attack and strokeand possibly save your life.
PAD Treatment Options
Patients who have peripheral artery disease should not smoke. In patients with PAD, people who smoke typically develop symptoms 10 years earlier than non-smokers. Smoking also increases the risk for heart attack and stroke even further.
Regular exercise is one of the most effective treatments for PAD. Exercise programs, which should be supervised by a physician, often include walking and leg exercises. Patients often are encouraged to alternate periods of activity with periods of rest to slowly increase the amount of time they are able to exercise without pain. In some cases, exercise is monitored in a rehabilitation center.
Try not to let pain stop you from being active. Research shows that a program of walking slows the progression of PAD. The NHLBI recommends a supervised program, with walking three times a week for 30 to 45 minutes a typical schedule. If you feel pain, stop and rest until you feel okay to continue. As with any exercise program, start slowly and gradually increase your time and pace. Talk to your doctor about what is best for you.
In patients who have peripheral artery disease, regular exercise can help improve circulation over time because it helps to promote the growth of new peripheral arteries (called collateral blood vessels).
In addition to regular exercise, other lifestyle changes that may be helpful include maintaining a healthy weight and eating a diet low in fat (especially saturated fat), cholesterol, and sodium (salt). Patients often are encouraged to eat plenty of fruits and vegetables and low-fat dairy products (e.g., skim milk).
Patients who have diabetes should be sure to follow the recommendations of a qualified health care provider for monitoring and controlling blood glucose (sugar) levels. Foot care is especially important in diabetics with PAD. Patients should be sure to wear shoes that fit properly and report any cuts, scrapes, or blisters that do not heal normally to a physician.
Medications may be used to treat peripheral artery disease. In some cases, mild pain responds to over-the-counter or prescription pain relievers (e.g., acetaminophen, nonsteroidal anti-inflammatory drugs [NSAIDs]). Intermittent claudication also may be treated with pentoxifylline (Trental) or cilostazol (Pletal). Side effects of these medications include headache, diarrhea, sore throat, and dizziness.
PAD treatment often requires medication to control medical problems that contribute to the condition, such as diabetes, high blood pressure, and high cholesterol. Insulin may be used to control blood glucose (sugar) levels in patients who have diabetes.
Other types of medication that may be used include the following:
- Antiplatelets to "thin" the blood and reduce the risk for blood clots (e.g., aspirin, clopidogrel [Plavix], protease-activated receptor-1 [PAR-1] antagonist vorapaxar [Zontivity; approved in May 2014])
- Blood pressure medications (antihypertensives)
- Angiotensin-converting enzyme (ACE) inhibitors (e.g., benazepril [Lotensin], captopril [Capoten], enalapril [Vasotec], fosinopril [Monopril])
- Angiotensin receptor blockers (ARBs; e.g., candesartan [Atacand], irbesartin [Avapro], losartin [Cozaar], telmisartin [Micardis], valsartan [Diovan])
- Beta blockers (e.g., atenolol [Tenormin], bisoprolol [Zebeta], carvedilol [Coreg], metoprolol [iLopressor, Toprol SL], timolol [Blockadren])
- Calcium channel blockers (e.g., diltiazem [Cardizem], verapamil [Calan, Covera HS, Isoptin, Veralan], amlodipine [Norvasc], felodipine [Plendil], idradipine [DynaCirc], nicardipine [Cardene], nisoldipine [Sular])
- Diuretics (e.g., hydrochlorothiazide [HydroDiuril, Microzide], acetazolamide [Diamox], furosemide [Lasix], indapamide [Lozol])
- Cholesterol-lowering medications
- Statins (e.g., atorvastatin [Lipitor], fluvastatin [Lescol], lovastatin [Mevacol], pravastatin [Pravachol], rosuvastatin calcium [Crestor], simvastatin [Zocor])
- Cholestyramine (LoCHOLEST, Questran)
- Colestipol (Colestid)
- Fenofibrate (Tricor)
- Fluvastatin (Lescol)
- Gemfibrozzil (Lopid)
- Niacin (Niacinol, Niacor)
When lifestyle modifications, exercise, and medications do not reduce PAD symptoms, surgery may be performed. Angioplasty involves making a small incision and inserting a tube (catheter) into the affected artery to the blockage. A tiny balloon is then passed through the catheter and is inflated to open (dilate) the artery.
A stent (tiny wire device that resembles a spring) may be placed into the artery during angioplasty and left in the artery so that it remains open. In some cases, medication is administered through the catheter to dissolve the plaque, or tiny instruments may be passed through the catheter and used to remove the blockage.
Severe PAD may require surgical treatment. The most common procedure is bypass surgery. Other types of surgery include removal of the lining of the affected artery (called endarterectomy) and repairing or replacing the artery (called an arterial graft). In bypass surgery, a blood vessel (vein or artery) from another part of the body is removed and implanted to redirect blood flow around the blocked artery.