Peripheral Arterial Disease of the Legs
Treatment Overview
As you begin your treatment for peripheral arterial disease (PAD), one of the first things you need to do is to make some lifestyle changes. These changes will improve your health and possibly reverse the buildup of plaque in your arteries. This can reduce your risk of heart attack and stroke.
Initial treatment
One of the single most important treatments for peripheral arterial disease (PAD) is to quit smoking. Quitting smoking is difficult, but you do not have to do it on your own. Your doctor can give you medicines such as bupropion (Zyban or Wellbutrin, for example) or varenicline (Chantix), to help you stop craving nicotine. Avoid secondhand smoke too.
There are also products that wean you off nicotine without using tobacco. This is called nicotine replacement therapy. It helps you gradually stop using nicotine. Products include nicotine patches, gums, nasal sprays, inhalers, and lozenges. These treatments help people quit smoking for a longer time. For more information, see the topic Quitting Smoking.
Because you have PAD, you have a high risk of having a heart attack or stroke. Your doctor will probably recommend that you follow a heart-healthy diet and increase your physical activity by walking. Even though walking causes you pain, it may be the best exercise you can get. You will need to rest as soon as the pain starts and walk a little farther after it goes away. Make sure you talk to your doctor first, before you start an exercise plan.
For more information on eating well, see:
You will probably need to take medicines, such as statins, to lower your cholesterol. You may also need to take aspirin or other antiplatelet medicines to help prevent blood clots from forming. If you have high blood pressure, you may need to take medicines to lower it. If you have diabetes, you will need to strictly control your blood sugar levels.
Avoid getting sick from the flu. Get a flu shot every year.
Ongoing treatment
A major part of treating leg pain from peripheral arterial disease is exercise. Studies show that walking 3 times a week for 3 to 6 months lengthens the distance you can walk before you need to stop because of leg pain.2 Being able to walk farther may mean that you are getting better blood flow to the muscles in your legs. An exercise program that is designed specifically for you may help you the most.
In many people, leg pain eases up after they have followed an exercise program for several months. But, if your leg pain does not get better, your doctor might prescribe a medicine called cilostazol (Pletal). This drug has been shown to help people walk longer before their pain starts, but it may have side effects.
If you are still smoking, your doctor will want you to quit and to stay on the heart-healthy diet. Keep taking any medicines your doctor prescribed at the beginning of your treatment.
If you have diabetes, your doctor will want you to closely monitor and control your blood sugar levels. Your doctor will also want you to manage other risk factors for heart attack and stroke, such as blood pressure and high cholesterol.
Also, watch for foot or leg sores, and treat them immediately. These sores may be slower to heal and more likely to become infected because of the reduced blood supply. People with diabetes need to be especially aware, because they often have peripheral neuropathy, a problem with the nerves that makes it harder to feel an injury to the legs or feet.
Treatment if the condition gets worse
Sometimes peripheral arterial disease continues to get worse despite treatment. This may be caused by continued smoking or other unhealthy choices. Other times, symptoms get worse because the disease has already progressed too far.
People who have severe PAD or who are at risk for losing a limb may need bypass surgery or other procedures (such as angioplasty and stenting) to restore proper blood flow to the legs. You may need surgery or angioplasty if you have symptoms of intermittent claudication and one of the following conditions:
- Your lifestyle or job is limited because of your symptoms.
- Exercise has not relieved your symptoms.
- Medicines have not relieved your symptoms.
In rare cases, a blood clot in an artery can suddenly and completely block blood flow to a leg or foot. Often, severe pain, numbness, and coldness develop within 1 hour. Clot-dissolving medicines, surgical removal of the clot, or bypass surgery may be needed to restore blood flow.
People with diabetes often have arterial disease that is both more severe and more widespread than in people who don't have diabetes. They commonly have neuropathy, which is a problem with the nerves that makes it harder to feel pain from an injury to the legs or feet. Ulcers can occur. These ulcers and injuries may be more prone to infection and gangrene (tissue death) because of the poor blood supply and poor function of the white blood cells in people who have diabetes.
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| Author: | Robin Parks, MS | Last Updated: October 16, 2009 |
| Medical Review: | E. Gregory Thompson, MD - Internal Medicine David A. Szalay, MD - Vascular Surgery | |
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