Treatment Options for PAD

Your health care provider will work closely with you to come up with a peripheral artery disease (PAD) treatment plan that improves your health and your quality of life. Be honest and open when you talk with your provider, so they understand your needs.

With treatment, you may stop PAD from getting worse and even reverse it. Treatment may include lifestyle changes, medication or surgery.

Lifestyle changes

Making these changes to your lifestyle can help improve your cardiovascular health and keep your symptoms under control.

• Quit smoking: Stopping tobacco use is the most important lifestyle change you can make to help with PAD. When you stop smoking, you improve your circulation and reduce your risk of cardiovascular problems.
• Move more: Exercise may improve your circulation and reduce symptoms. Walking and cycling are good choices. Start slowly and gradually make your activity longer and more intense. You may also want to try a supervised exercise program, where you can get guidance and support tailored to your needs.
• Choose a healthy diet: A balanced diet should include:
  • High-fiber foods such as fruits, vegetables and whole grains
  • Lean proteins like fish, poultry, beans and nuts
  • Healthy fats including olive oil, avocados and nuts
  • Limited amounts of saturated and trans fats, cholesterol and sodium
• Control stress: Mindfulness, meditation, yoga and relaxation exercises can help you keep your stress levels managed.
• Avoid medications that contain pseudoephedrine: Some over-the-counter (OTC) cold and sinus medications can tighten blood vessels, which can make your PAD symptoms worse. Check with your pharmacist for safer options.
• Take good care of your feet: PAD puts you at risk of slow-healing foot sores and cuts, so try to avoid injuring your feet. Wash them daily, wear comfortable shoes and socks, treat any infections, be careful when you’re cutting your toenails and check your feet every day so you can fix any problems immediately.
• Sleep with the head of your bed raised: This can help with nighttime leg pain.

Medications

Your providers may recommend one or more medications to treat PAD. It’s important to take medications as prescribed, follow up regularly with your provider and talk to your health care team about any concerns or side effects.

• Antiplatelet medications: Medications like aspirin or clopidogrel may help prevent blood clots from forming in the arteries. This may improve circulation, reduce PAD symptoms and make complications less likely.
• Cholesterol-lowering medications: Statins and other cholesterol-lowering medications may help slow plaque buildup and reduce your risk of other cardiovascular conditions.
• Blood pressure medications: It’s important to control your blood pressure if you have PAD. Keeping your blood pressure in the recommended range can help reduce complications such as heart attack and stroke. Medications such as ACE inhibitors or beta-blockers may help reduce stress on the artery walls, promote better blood flow and improve cardiovascular health.
• Blood sugar medications: If you have diabetes, it’s important to keep your blood sugar in a healthy range.
• Symptom management medications: Medications like cilostazol and pentoxifylline aim to reduce the leg pain caused by PAD when you’re walking or physically active. They work by widening the blood vessels to improve circulation. These medications may make it easier for you to exercise and may improve your quality of life.

Surgery

In some cases, you may need a surgical procedure to treat PAD. Surgery may improve blood flow, relieve symptoms, lower the risk of complications, improve mobility and reduce pain.

The three main options are atherectomy, angioplasty and stenting and bypass surgery.

Atherectomy 

A  surgeon threads a catheter through your artery to the blocked area, then uses a laser or a small blade to cut out the plaque. The plaque is then removed through the catheter. Atherectomy is a minimally-invasive procedure and most people can go home the same day.

Angioplasty and stenting

A surgeon threads a small, deflated balloon to the part of your artery that is blocked. They then inflate the balloon to push the plaque against the artery walls and widen the artery.

In some cases, the surgeon will insert a stent (a small, mesh tube) into the area. The stent stays in the artery to help keep it open.

Bypass surgery

Also called peripheral artery bypass grafting, surgeons create an alternate route so blood can flow around a blocked or narrowed artery.

In this surgery, the surgeon will take a synthetic tube or a blood vessel from another part of your body and carefully connect it above and below the blocked section of the artery. This creates a new path where the blood can flow, bypassing the blockage.

Bypass surgery is a major procedure, so health care providers usually consider other options first. It may be recommended if:

• You have multiple arteries affected by PAD.
• You have long or complex blockages.
• Angioplasty and stenting didn’t work well.
• Your blood flow is so compromised that you are at risk for amputation.

Complications

It’s important to treat and manage PAD. Without treatment, symptoms can get worse. It can be hard to walk or be active, putting limits on your life. Plus, having PAD can put you at risk for:

• Stroke and heart attack, since the plaque buildup you have in PAD can also affect the brain and heart and increase your risk for coronary artery disease.
• Critical limb ischemia, where tissue doesn’t get enough blood flow and dies. If this happens, you could need amputation.

The good news is that with treatment and follow-up visits with your health care provider, PAD can be controlled - and sometimes symptoms can even be reversed.