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Atherosclerosis

Atherosclerosis (sometimes called “hardening” or “clogging” of the arteries) is the buildup of cholesterol, fatty cells and inflammatory deposits (called plaque) on the inner walls of the arteries that restrict blood flow to the heart. Atherosclerosis can affect the arteries in the heart, legs, brain, kidneys and other organs.

The type of atherosclerosis known as peripheral arterial disease (PAD) , peripheral vascular disease (PVD) and lower extremity vascular disease occurs in the vessels that carry blood to the arms and .  In healthy arteries, a smooth lining prevents blood from clotting and promotes steady blood flow. In PAD/PVD, the arteries slowly become narrowed or blocked when plaque gradually forms inside the artery walls. If the arteries become narrowed or blocked, blood cannot get through to nourish the tissues, causing the muscles of the lower extremities to cramp and lose strength.  This process of cramping in the legs when walking is called “intermittent claudication.”

Blockage in arteries to the kidneys and intestines can lead to poor blood flow to these organs and ultimately tissue damage.The rate at which atherosclerosis progresses varies with each individual and depends on many factors, including where in the body the plaque has formed and the person’s overall health.

What are the treatment options for atherosclerosis/peripheral arterial disease/peripheral vascular disease?

Atherosclerosis treatments include lifestyle changes, medications and procedures, both nonsurgical and surgical.

Nonsurgical Treatment Options for Atherosclerosis/Peripheral Arterial Disease/Peripheral Vascular Disease

Lifestyle changes. Making lifestyle changes can reduce your risk factors that lead to development of atherosclerosis or plaque blocking your arteries. Changes you can make to reduce your risk include:

  • Quit smoking. Cleveland Clinic offers  smoking cessation programs.
  • Eat a  balanced diet that is high in fiber and low in cholesterol, fat and sodium. Limit fat to 30 percent of your total daily calories. Saturated fat should account for no more than 7 percent of your total calories. Avoid trans fats including products made with partially-hydrogenated and hydrogenated vegetable oils. If you are overweight, losing weight will help you lower your total cholesterol and raise your HDL (good) cholesterol. A registered dietitian can help you make the right dietary changes.
  • Exercise. Begin a regular exercise program, such as walking. Walking is very important and can aid the treatment of PAD. Patients who walk regularly can expect a marked improvement in the distance they are able to walk before experiencing leg pain. Ask your doctor if your hospital or clinic offers a structured, supervised walking program to help you succeed and maximize your exercise efforts.
  • Manage other related health problems, such as  high blood pressure diabetes, or  high cholesterol .
Medications

May be recommended to treat conditions such as high blood pressure (anti-hypertensive medications) or high cholesterol (statin medications).

  • An antiplatelet medication such as aspirin or clopidogrel (Plavix) may be prescribed to reduce the risk of heart attack and stroke.  Often, patients may be prescribed both of these medications to reduce the risk of cardiovascular complications such as heart attack or stroke.
  • Cilostazol (Pletal) may be prescribed to improve walking distance. This medication has been shown to help some people with intermittent claudication exercise longer before they develop leg pain and to walk longer before they must stop because of the pain. However, not all patients are eligible to take this medication, and in some situations, other therapies can provide better relief of your leg pain. Your doctor will tell you if you are eligible.

When is a procedure to improve the flow to the leg for atherosclerosis/PAD/PVD necessary?

When lifestyle changes and medication may not be enough to improve your symptoms, or if your disease has advanced, your physician may recommend surgical or minimally invasive treatments. The choice of the treatment depends upon the pattern and extent of the blockages as well as other factors, such as your general health and the presence of other medical conditions.

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