Treatment

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Treatment goals for peripheral arterial disease (PAD) always include reducing your risk of heart attack and stroke by immediately controlling your risk factors and through the use of medications. Additional goals are to improve your leg symptoms, if these are present, and to reduce the risk of amputation. Once again, it is extremely important that any risk factors be recognized and treated promptly so that your PAD doesn't get worse.

Lifestyle Changes

Lifestyle can profoundly affect your health. If you expose your arteries to damaging factors, you should note that other treatments may not be effective and your health is likely to deteriorate. On the other hand, successful control of your daily habits can usually be enough to slow the progression or even reverse symptoms of PAD. These beneficial lifestyle changes include:

• Stop smoking immediately. This is critical because all tobacco products directly damage the arteries, and nicotine further narrows the blood vessels.

• Exercise. Regular exercise is the most consistently effective treatment for people with PAD, helping reduce cholesterol levels, improve weight loss and maintain healthy circulation. Conditioning your muscles with exercise makes them more efficient so they can do more work (e.g., walking) before symptoms develop.

  Exercise programs are most effective when performed in a supervised setting such as a cardiac rehabilitation program. Simple walking regimens on a treadmill, outdoors or in malls for at least 30 to 60 minutes, three to four times a week, may also help. Your health care professional is likely to ask you to walk each day until leg discomfort develops, then rest, then continue walking until the pain develops again. The goal is to travel longer distances without pain each time you walk.

• Watch your diet. Many people with PAD have high cholesterol and blood pressure levels. A healthful, balanced diet low in saturated fat, salt and cholesterol, and rich in fruits, vegetables, whole grains, beans, fish and low-fat dairy products may help lower cholesterol levels and high blood pressure. However, some people may require medication to reduce cholesterol and/or blood pressure levels and keep them low.

• Maintain good foot hygiene. Check your feet each day for sores, redness or swelling. Wash your feet every day and apply a moisturizing lotion; tuck cotton or lamb's wool between your toes if the skin is starting to crack; and wear cotton socks and comfortable, breathable shoes made of natural materials. Avoid injuring your feet.

Medications

Treatment for PAD always includes the use of medication to reduce the risk of heart attack and stroke and improve symptoms. Medications used include:

• Antiplatelet medications, such as aspirin or clopidogrel (Plavix). Both help reduce the risk of blood clots. Side effects of aspirin include stomach ulcers or other serious bleeding complications. Serious side effects of clopidogrel include allergic reaction, bleeding complications, severe headache, confusion or dizziness. Other, less serious side effects may include upset stomach, diarrhea or constipation, or headache or dizziness.

• Cholesterol-lowering drugs such as statins. These drugs not only lower cholesterol but also improve the health of the lining of the arteries (endothelium) and reduce the likelihood that an artery will slowly clog or suddenly be blocked by a blood clot.

  Statin medications are among the safest drugs available, and most individuals tolerate them with no difficulty. However, possible side effects include nausea, gas, constipation and muscle pain. Your physician will also monitor your liver function. Any side effects are usually mild and fade as your body adjusts to the drug. All individuals will, from time to time, regardless of medication use, feel muscle soreness. However, if you experience any unusual or persistent muscle soreness or weakness while using these medications, contact your health care professional immediately.

• Cilostazol (Pletal). This drug widens the arteries that supply blood to the legs and is the most effective claudication medication. Side effects are rare and include headache, mild palpitations, loose stools and nausea. You should not take this medication if you have congestive heart failure.

• Pentoxifylline (Trental). Used to improve blood flow by changing the shape of the blood cells and to reduce claudication, this medication is much less effective than cilostazol, however, and isn't used as often. Side effects include insomnia, nervousness or red eyes, or, in more severe cases, an allergic reaction, chest pain, irregular heartbeat, severe dizziness, headache, nosebleeds, blurred vision, nausea, vomiting and swollen feet or ankles. This drug is usually considered a "second line" medication.

Nonsurgical Procedures

There are a number of ways health care professionals can open blood vessels at the site of blockages and restore normal blood flow. All of these invasive PAD treatments, whether based on use of a catheter or surgery, are most useful for individuals whose blockages are not widespread or whose blockages are in the arteries closer to the groin.

In these instances, a nonsurgical endovascular procedure can sometimes bring swift relief and may be more cost-effective than surgery. Most endovascular procedures require no more than an overnight hospital stay and little down time afterward.

In these procedures, a tiny tube called a catheter is inserted into an artery to open the blockage. The most common procedures treat the plaque by compressing it and/or displacing it with a metal coil inserted within the artery, called a stent. The two main procedures are:

• Angioplasty. With the help of a catheter and x-ray guidance, a tiny balloon is inserted into the blood vessel through a small opening in the skin and moved through the artery to the site of the blockage, then inflated to open the blood vessel.

• Stenting. A tiny metal cylinder or "stent" is permanently inserted in the clogged vessel, where it acts like a scaffold to hold it open. Many stents today are coated with medication to prevent the artery from getting clogged again.

More rarely, physicians may identify a clot that is blocking an artery, stent or bypass graft. If so, "thrombolytic therapy" may be used:

• Thrombolytic therapy. If you have a clot that's blocking an artery, your doctor may inject a clot-dissolving drug into your artery where the clot is located to break it up.

Surgery

If surgery is required, possible procedures include:

• Endarterectomy. This procedure is used when a very short segment of an artery is blocked or severely clogged. The surgeon identifies the location of the blockage with an arteriogram, then makes an incision over the area and removes the plaque in the artery's inner lining. This procedure opens the artery, restoring blood flow. It works well for a clogged carotid artery in the neck. It is used less often for blockages of the leg arteries, where it is usually used for the groin arteries.

• Bypass. If the blockage is extremely long or has become very hard and calcified with time, surgery may be required to bypass the problem area. A bypass graft involves grafting part of a vein from another part of the body or a synthetic blood vessel onto the artery so the blood supply can bypass the diseased region of the artery.

• Amputation. In rare cases, gangrenous tissue (such as a toe, foot or leg) may have to be removed permanently.