Peripheral Vascular Disease

Treatment

Treatment programs are tailored to each individual and take into account the needs of the patient and family. The treatment will depend on factors such as the severity of the symptoms, the degree of arterial narrowing or blockage and the patient's overall health. Treatment for patients with PVD is provided in three areas:

• 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 PVD who have open wounds or vascular ulcers that won't heal.

Controlling Risk Factors and Lifestyle Changes

Peripheral vascular disease is a common condition among people who have diabetes and those who smoke. It is critical for diabetics to control their blood sugar levels and for smokers to quit smoking completely.

Other essential lifestyle changes are diet and exercise. Diet changes include reducing the amount of cholesterol-containing (fatty) foods and, for overweight people, reducing calories to decrease weight. Exercise helps in weight loss and in building a stronger circulatory system and improving blood flow. Even though peripheral vascular disease may cause pain during exercise, a program of daily walking for short periods may help the person maintain or regain function.

It is also critical for patients with peripheral vascular disease, particularly those with diabetes, to carefully monitor their feet for cuts or wounds and avoid tight-fitting shoes.

Medications

Patients with peripheral vascular disease may benefit from medications to reduce the risk of heart attack and stroke. Among the more commonly prescribed drugs are:

Antiplatelet drugs
These medications make the blood platelets less likely to stick together. Sticky platelets, which are more 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 of these drugs, and typically has the fewest potential side effects.

Anticoagulants
These prescription drugs prevent blood clots by affecting the proteins in the body's clotting system and require careful monitoring. The drugs include heparin, which is used short term, and warfarin (Coumadin), which is used long term.

Cholesterol-lowering drugs
By decreasing the amount of cholesterol, especially LDL (the "bad" form of cholesterol), these drugs decrease the primary material that make up deposits that narrow or plug arteries and create atherosclerosis. Examples of these drugs are niacin, statins, fibrates and bile acid sequestrants. Some foods and margarines are now available with special cholesterol-lowering ingredients.

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

Vitamins
Folate, B-6 and B-12 are vitamins that help to decrease homocystine in the blood. In specific situations, other dietary supplements may be prescribed, such as L-arginine and Omega-3 fatty acids.

Endovascular Therapy (from within the blood vessel)

Angioplasty and Stenting
In this procedure, 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, which is a kind of wire mesh tube, is left in place to keep the artery from collapsing after balloon angioplasty.

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 when they get home.

Surgery

Surgery is the appropriate option for those patients with severe cases of PVD, such as when the disease interferes with daily activities. There are several surgical treatments, including:

Endarterectomy
In this procedure, 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 or a bypass, using a vein or artificial blood vessel (graft) blood vessel.