Peripheral Arterial Disease

Treatment

At Mayo Clinic, treatment programs for patients with peripheral arterial disease are tailored to each individual and take into account the needs of the patient and family. Treatment depends on factors such as the severity of the symptoms, the degree of arterial narrowing or blockage, and the patient's overall health.

Treatment programs for patients with peripheral arterial disease may include:

• Controlling risk factors through lifestyle changes and medication
• Endovascular therapy or surgery to reopen arteries to the legs or arms
• Specialized care for patients with vascular ulcers or open wounds that won't heal, such as hyperbaric oxygen therapy

Controlling Risk Factors

Peripheral arterial disease is common among smokers and people who have diabetes. It is critical for diabetics to control their blood sugar levels and for smokers to quit smoking. Also critical for patients with PAD, and particularly those with diabetes, is to carefully monitor their feet for cuts or wounds and avoid tight-fitting shoes.

Diet and Exercise

Patients with peripheral arterial disease must reduce the amount of cholesterol-containing (fatty) foods in their diet. Overweight patients must also reduce their daily calorie intake to lose weight.

Exercise helps patients lose weight and build a stronger circulatory system, improving blood flow. Although patients with peripheral arterial disease may experience pain during exercise, a program of daily walking for short periods may help maintain or regain function.

Medications

Patients with peripheral arterial disease may benefit from medications to reduce the risk of heart attack and stroke. Several types of drugs commonly are prescribed:

Antiplatelet Drugs

Antiplatelet drugs make blood platelets less likely to stick together. Sticky platelets, which are common in damaged blood vessels, may form a blood clot and lead to a stroke or heart attack. Aspirin is the most common, least expensive, antiplatelet drug and typically has the fewest potential side effects.

Anticoagulants

Anticoagulants prevent blood clots by affecting the proteins in the body's clotting system. They require careful monitoring. Heparin, which is used short term, and warfarin, which is used long term, are both anticoagulants.

Cholesterol-lowering Drugs

By decreasing the amount of cholesterol, especially low-density lipoprotein (LDL), these drugs decrease the primary material that makes up deposits that narrow or plug arteries and create atherosclerosis (hardening of the arteries). Examples of these drugs include niacin, statins, fibrates and bile acid sequestrants.

Calcium Channel Blockers

Calcium channel blockers help dilate arteries and control high blood pressure.

Vitamins

Folate, B-6 and B-12 are vitamins that help to decrease homocystine in the blood. Other dietary supplements, such as L-arginine and omega-3 fatty acids, may also be prescribed.

Endovascular (Within the Blood Vessel) Therapy

In angioplasty and stenting, a balloon is attached to a catheter (a long, thin tube) that is inserted in the groin artery and threaded through the arteries to the narrowed peripheral arteries. The balloon is then inflated to open the narrowed areas. In some cases, a metal stent (a wire mesh tube) is left in place to keep the artery from collapsing.

Patients are typically given a mild sedative during the procedure and are usually discharged from the hospital the following day. Most patients are able to resume normal activities immediately.

Surgery

Surgery is the appropriate option for those patients with severe cases of peripheral arterial disease that interfere with daily activities. There are several surgical treatments.

Endarterectomy

In endarterectomy, the surgeon cleans out the plaque buildup inside the artery of the affected leg or arm.

Grafting or Bypass

In grafting or bypass, the surgeon replaces the section of blocked artery with a graft (replacement section of vein or artificial blood vessel) or a bypass (a vein or artificial blood vessel that channels blood around the blockage).