Treatment for peripheral artery disease has two major goals. The first is to manage symptoms, such as leg pain, so that you can resume physical activities. The second is to stop the progression of atherosclerosis throughout your body to reduce your risk of heart attack and stroke.
You may be able to accomplish these goals with lifestyle changes. If you smoke, quitting is the single most important thing you can do to reduce your risk of complications.
If lifestyle changes are not enough, you need additional medical treatment. Your doctor may prescribe medicine to prevent blood clots, lower blood pressure and cholesterol, and control pain and other symptoms.
- Cholesterol-lowering medications. You may take a cholesterol-lowering drug called a statin to reduce your risk factor of heart attack and stroke. The goal for people who have peripheral artery disease is to reduce low-density lipoprotein (LDL) cholesterol, the "bad" cholesterol, to less than 100 milligrams per deciliter (mg/dL), or 2.6 millimoles per liter (mmol/L). The goal is even lower if you have additional major risk factors for heart attack and stroke, especially diabetes or continued smoking.
- High blood pressure medications. If you also have high blood pressure, your doctor may prescribe medications to lower it. The goal of this therapy is to reduce your systolic blood pressure (the top number of the two numbers) to 140 millimeters of mercury (mm Hg) or lower and your diastolic blood pressure (the bottom number) to 90 mm Hg or lower. If you have diabetes, your blood pressure target is under 130/80 mm Hg.
- Medication to control blood sugar. If you also have diabetes, it becomes even more important to control your blood sugar (glucose) levels. Talk with your doctor about what your blood sugar goals are and what steps you need to take to achieve these goals.
- Medications to prevent blood clots. Because peripheral artery disease is related to reduced blood flow to your limbs, it's important to reduce your risk of blood clots. A blood clot can completely block an already narrowed blood vessel and cause tissue death. Your doctor may prescribe daily aspirin therapy or another medication that helps prevent blood clots, such as clopidogrel (Plavix).
- Symptom-relief medications. The drug cilostazol (Pletal) increases blood flow to the limbs both by preventing blood clots and by widening the blood vessels. It specifically helps treat symptoms of claudication, such as leg pain, for people who have peripheral artery disease. Common side effects of this medication include headache and diarrhea. An alternative to cilostazol is pentoxifylline (Trental); however, it's generally less effective. But, side effects are rare with this medication.
Angioplasty and surgery
In some cases, angioplasty or surgery may be necessary to treat peripheral artery disease that's causing intermittent claudication:
- Angioplasty. In this procedure, a small hollow tube (catheter) is threaded through a blood vessel to the affected artery. There, a small balloon on the tip of the catheter is inflated to reopen the artery and flatten the blockage into the artery wall, while at the same time stretching the artery open to increase blood flow. Your doctor may also insert a mesh framework called a stent in the artery to help keep it open. This is the same procedure doctors use to open heart arteries.
- Bypass surgery. Your doctor may create a graft bypass using a vessel from another part of your body or a blood vessel made of synthetic fabric. This technique allows blood to flow around — or bypass — the blocked or narrowed artery.
- Thrombolytic therapy. If you have a blood clot blocking an artery, your doctor may inject a clot-dissolving drug into your artery at the point of the clot to break it up.
Supervised exercise program
In addition to medications or surgery, your doctor may prescribe a supervised exercise training program to increase the distance you can walk pain-free. Regular exercise improves symptoms of PAD by a number of methods, including helping your body use oxygen more efficiently.
June 22, 2012
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- Mohler III ER. Clinical features, diagnosis, and natural history of lower extremity peripheral arterial disease. http://www.uptodate.com/index. Accessed May 8, 2012.
- Prevention and treatment of PAD. American Heart Association. http://www.heart.org/HEARTORG/Conditions/More/PeripheralArteryDisease/Prevention-and-Treatment-of-PAD_UCM_301308_Article.jsp. Accessed May 8, 2012.
- Hirsch AT, et al. ACC/AHA 2005 guidelines for the management of patients with peripheral arterial disease. Journal of the American College of Cardiology. 2006;47:e1.
- Rooke TW, et al. 2011 ACCF/AHA focused update of the guideline for the management of patients with peripheral arterial disease. Circulation. 2011;124:2020.
- Kuller LH. Does ginkgo biloba reduce the risk of cardiovascular events? Circulation: Cardiovascular Quality and Outcomes. 2010;3:41.
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