How is PAD treated?

Lifestyle changes, medications and interventional procedures are the treatments available for PAD.

Lifestyle Changes. Initial treatment of PAD includes making lifestyle changes to reduce your risk factors. Changes you can make to manage your condition include:

  • Quit smoking. Ask your doctor about smoking cessation programs available in your community.
  • 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. (See Walking Program Box)
  • Manage other health conditions, such as high blood pressure, diabetes or high cholesterol.
  • Practice good foot and skin care to prevent infection and reduce the risk of complications. (See Foot Care Guidelines Box)

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.

Walking Program

Vascular Medicine and Preventive Cardiology and Rehabilitation offer a structured supervised walking program to help you succeed and maximize your exercise efforts. Please call 216.444.4420 or 800.223.2273 ext. 4420 to make an appointment.

Cilostazol (Pletal) may be prescribed to improve walking distance. This medication has been shown to help 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. Your doctor will tell you if you are eligible.

Interventional procedures. More advanced PAD can be treated with interventional procedures such as angioplasty (to widen or clear the blocked vessel), angioplasty with stent placement (to support the cleared vessel and keep it open), or atherectomy (to remove the blockage).

In some cases, surgical procedures such as peripheral artery bypass surgery may be performed to reroute blood flow around the blood vessel blockage.

New therapies are currently being researched. Please ask your doctor if any other treatment options are available for you.

If any of these procedures are recommended, your health care team will give you more information about the procedures so you will know what to expect.

Can PAD be cured?

There is no cure for PAD. Quitting smoking, exercising regularly, limiting fat and following a healthy diet, and managing your risk factors — such as diabetes, high cholesterol and high blood pressure — can help to reduce the progression of the disease.

Foot Care Guidelines

Every day, examine your legs as well as the tops and bottoms of your feet and the areas between your toes. Look for any blisters, cuts, cracks, scratches or other sores. Also check for redness, increased warmth, ingrown toenails, corns and calluses. Use a mirror to view the leg or foot if necessary, or have a family member look at the area for you.

Once or twice a day, apply a moisturizing cream or lotion to your legs and soles and top of your feet to prevent dry skin and cracking. Do not apply lotion between your toes or on areas where there is an open sore or cut. If the skin is extremely dry, use the moisturizing cream more often. Care for your toenails regularly. Cut your toenails after bathing, when they are soft. Cut toenails straight across and smooth with a nail file.

If you have diabetes, it is important to see a podiatrist.

Do not self-treat corns, calluses or other foot problems. Go to a podiatrist to treat these conditions.

Don't wait to treat a minor foot or skin problem. Follow your doctor's guidelines.

Other tests may include angiography, CT scan or MRI.

During angiography (also called arteriography), contrast material (dye) is injected into the blood vessels being examined, and X-ray pictures of the inside of the blood vessels are produced to evaluate blood flow and detect possible blockages.

A CT scan is a technique in which multiple X-rays are taken from different angles in a very short period of time. The images are collected by a computer and cross-sectional “slices” of the blood vessel are shown on the monitor.

MRI uses powerful magnets to create images of internal organs and blood vessels.

Taking Control of Peripheral Arterial Disease

Despite the prevalence of PAD, it is surprisingly underdiagnosed and undertreated (3). The good news is that, although PAD is a serious condition with potentially serious consequences, it is treatable. Like most health conditions, PAD is more treatable when it is detected early.Being aware that you have risk factors for PAD may motivate you to take action to prevent PAD from developing. The same advice for maintaining a healthy heart applies to maintaining healthy circulation overall:

  • Manage your weight
  • Eat a low fat, low sugar diet that includes at least five servings of fresh fruits and vegetables every day
  • Don’t smoke.
  • With your doctor’s approval, exercise, doing an activity you enjoy, for at least 30 minutes a day on most days of the week.

If you have heart disease, you should discuss your risk factors for PAD with your doctor and report any symptoms you are having such as pain, weakness or numbness in the legs. Your doctor may order a simple test, known as the ankle-brachial index (ABI), to diagnose PAD The ABI test involves measuring the blood pressures in the arms and the legs using a hand-held Doppler device.

If you already have mild PAD, your doctor may prescribe exercise therapy, dietary changes, smoking cessation and medication. Common medications prescribed for atherosclerosis and PAD include anti-platelet agents (such as aspirin or clopidogrel) and cholesterol lowering medications (“statins”). The best things that you can do for yourself in this situation are to quit smoking, control your high blood pressure, take your medications, and manage your diabetes.

It is also very important that patients with PAD take especially good care of the feet to prevent non-healing sores. Important components of foot care for patients with PAD include: wearing comfortable, appropriately fitting shoes; inspecting the feet regularly for sores; keeping the feet clean and well moisturized; and, taking regular care of the toe nails. In some cases, a patient with PAD is referred to a podiatrist for specialized foot care.

Other Treatments for Peripheral Arterial Disease

More advanced PAD that is causing severe pain and limited mobility may require endovascular (i.e., minimally invasive) or surgical treatment. Some of the same treatments that are used for heart disease are also used for treating PAD.

Balloon angioplasty:

In this procedure, a miniature balloon is passed through a catheter into the arteries. As the balloon is expanded inside the artery, it pushes against the plaque and opens up the artery.

Stents:

These are tiny metal support coils that are inserted into the arteries. Once they are in place, stents expand against the inner blood vessel wall to support it and hold it open. Stents can be placed through a small opening using catheters (long, thin tubes) without major surgery.

Bypass surgery:

Similar to heart bypass, a surgeon uses a section of the patient's healthy vein or a synthetic replacement to create a bypass around the blocked area in the leg artery. This is usually reserved for the most severe PAD.

With early diagnosis, lifestyle changes and treatment, you can stop PAD from getting worse. In fact, some studies have shown that symptoms due to PAD can be reversed with exercise combined with careful control of cholesterol and blood pressure. If you think you are at risk for PAD or may already have the disease, talk to your primary care doctor or cardiologist so that you can get started on a prevention or treatment program as soon as possible. With proper diagnosis and treatment, you can still enjoy the good things in life - like shopping, sightseeing and golf!

For questions or more information about PAD, call the Miller Family Heart & Vascular Institute Resource and Information Center Nurse at 216.445.9288 or toll-free 866.289.6911. For an appointment with a Cleveland Clinic women’s heart or vascular specialist, call toll-free 800.223.1696 or locally, 216.444.9343.

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