Peripheral Artery Disease
(PAD)
Treatment
Plaque buildup in the arteries (atherosclerosis), which is the cause of peripheral artery disease (PAD), continues to accumulate in our arteries throughout our lives, so it can’t be cured. However, the successful management and treatment of your PAD can make a significant difference in your life by:
- Reducing your risk of heart attack and stroke
- Relieving pain and other symptoms that have been preventing you from doing the many things you used to enjoy
- Saving your legs and feet from serious infection, gangrene, and amputation
The type of treatment you receive for PAD, as with cardiovascular disease in general, depends on your personal circumstances, the extent of disability and risk, and the nature of the problem.
If you have PAD, your doctor will assess the severity of your condition and where you best fit among a range of treatment options, which is sometimes referred to as the “spectrum of care.” The spectrum of care options for your PAD will consist of a combination of lifestyle changes, medications, procedures, or surgery, but you can work with your doctor to determine which treatment options make the most sense for you based on your desired quality of life.
Lifestyle changes
You’re the most important player in the treatment of your peripheral artery disease (PAD), and making certain lifestyle changes can help significantly reduce your symptoms of PAD and slow its development. Even if you don’t have PAD, these lifestyle changes can also significantly reduce your risk of developing PAD in the first place while, at the same time, lowering your risk for a heart attack and stroke.
- Stop smoking – This is a big risk factor for PAD, as it’s the first and most successful line of treatment. Unlike alcohol, there’s no safe level of cigarette smoke. You may have even tried to quit before, but it’s really hard. Work with your doctor to give it another try—this might be the time you can quit for good.
- Start walking – Walking is another very effective way to treat your PAD, as it can help increase blood flow to your legs and aid in reducing leg pain and cramps for many people with PAD. In many cases, the best treatments for PAD are not medicines and medical procedures—it’s a prescription for exercise. Start a walking program under your doctor’s supervision and set reasonable goals.
- Take care of your feet – It’s very important—especially if you have PAD and diabetes—that you take good care of your feet. Check your feet daily and check for skin changes and sores. If you have PAD and get sores on your feet, they may not heal easily. Set yourself a daily reminder of this important self-care item.
- Avoid the cold and dress in layers – Some people find cold weather aggravates their pain symptoms.
- Read labels on your over-the-counter medications – You should always read the labels on any over-the-counter medications you plan to take, as they may cause issues with people who have PAD and may interact with certain prescribed medications that you may be taking. Check with your doctor if you have any questions.
- Live a healthy life – Living a healthy life, including managing stress, exercising, and eating healthy, is extremely beneficial for cardiovascular health.
- Join a cardiac rehabilitation program – Recent studies have shown that people who attend cardiac rehabilitation are more likely to be alive and well five years after diagnosis than those who do not. Joining a cardiac rehabilitation program can help you resume a healthy lifestyle, such as eating a healthy diet and exercising regularly.
- Control your risk factors – Maintaining a heart-healthy lifestyle will help you manage risk factors for PAD, including blood pressure, cholesterol, and diabetes.
Medications
If you have PAD, your doctor will treat you like you already have coronary artery disease (CAD). This is because if you have PAD, there is a very good chance you also have CAD. And the same applies if you have CAD—it’s very likely you have PAD, too.
So, in addition to making lifestyle changes, your doctor will probably prescribe medications, even if you don’t currently have symptoms of CAD. Medications can help prevent a further buildup of plaque in your arteries and reduce your risk of serious cardiovascular events such as a heart attack or stroke. The medications used to treat PAD (and CAD) include the following:
|
Medication Type |
Purpose |
|---|---|
|
Aspirin |
To ward off blood clots and help prevent a heart attack |
|
Angiotensin-converting-enzyme (ACE) inhibitors (Accupril, Lotensin, Prinivil, Vasotec) |
To treat high blood pressure and help prevent a heart attack |
|
Beta-blockers (Lopressor, Coreg, Bystolic, Tenormin, Zebeta) |
To slow the heart rate, reduce the heart's demand for oxygen, help prevent a heart attack, reduce high blood pressure, and reduce angina symptoms |
|
Cilostazol (Pletal) |
To help with symptoms of claudication (leg pain caused by poor circulation) |
|
Clopidogrel (Plavix) |
To prevent excessive clotting as well as lower stroke and heart attack risk in patients with PAD |
|
Statins and other cholesterol-lowering medications (Lipitor, Zocor, Crestor, Pravachol) |
To lower blood levels of LDL (the “bad" cholesterol) and raise levels of HDL (the "good" cholesterol), slowing or stopping plaque buildup in the arteries |
|
Calcium-channel blockers (Isoptin SR, Calan SR) |
To relax blood vessels, which reduces high blood pressure and lightens your heart's workload as it pumps blood throughout the body, and slow the heart rate |
|
Nitroglycerin |
To relax the arteries and veins, which lightens the heart's workload by reducing the pressure the heart has to pump against and help prevent angina |
Procedures and surgery
For patients with more advanced PAD, where the arteries in your legs have become clogged and narrowed so that blood flow can’t supply enough oxygen to your leg muscles, your doctor may recommend certain procedures or surgery to restore blood flow to the muscles. These procedures include the following:
- Angioplasty and stenting – This interventional procedure is performed inside the blood vessels using a small, flexible tube called a catheter. It’s also commonly used to treat blocked arteries to the heart to restore blood flow and stop chest pain (angina), halt a heart attack, or lower the risk of heart attack or stroke.
- Bypass surgery – Surgery is another option for restoring blood flow to your legs or, in some cases, your arms. If a lengthy portion of an artery becomes narrowed or a blood vessel is severely blocked, your doctor may recommend bypass surgery. Blood flow is restored by rerouting the blood around the blockage to reduce leg pain and the risk of losing a leg or foot due to severe narrowing of the arteries.
Watch this animation to learn about how angioplasty and stents are used to treat heart conditions.
If pain returns following your procedure
Arteries can become blocked again after they’ve been treated. A re-narrowing of the artery, called restenosis, may cause you to experience leg or foot pain. If you feel leg or foot pain after you’ve been treated, call your doctor. A second procedure may be needed to widen the artery again.
If PAD is left untreated
If you’ve already had PAD for some time without realizing it, you might have pain in your legs, feet, and toes all the time—even while you’re resting. Watch for sores on your feet and toes, as you could have critical limb ischemia (CLI) or severely blocked arteries in your legs. If blood flow to your legs and feet continues to be restricted, the sores will not receive the oxygen and nutrients they need to heal, and the affected tissue may die and develop gangrene. The toes, feet, and legs affected by gangrene may have to be amputated.
Of course, it’s better to get help long before you reach this stage—not only to avoid sores and gangrene but because PAD indicates that your blood might not be making it to your heart, brain, or kidneys as it should. You may already have trouble walking and doing other activities you could do before PAD, but a heart attack or stroke could restrict you even more.