Treatment and Prevention
PAD does most of its damage during its "silent" stage, before
the person is aware of having it. Even so, most doctors don't favor routine
screening to find silent PAD, as it would cause many patients to undergo unnecessary
invasive tests. However, people with health problems or lifestyles that could
lead to PAD should be watched closely for any symptoms and then tested as needed.
If you show symptoms and are diagnosed with PAD, your doctor might recommend
some lifestyle changes that can slow down its progress. The advice will
include the following:
- Eat a healthy diet. Cut down on foods that contribute to high cholesterol
and high blood pressure.
- Exercise. Take walks, take up gardening, or use the stairs instead
of an elevator, for example. Exercise helps lower blood pressure, increases
blood circulation, strengthens the arteries to improve blood flow, and can
help you lose weight.
- Raise the head of your bed by four to six inches. This can also help
improve blood flow to your legs.
- Stop smoking. Most people who stop smoking see improvement in their
PAD symptoms.
- Take the medications prescribed for diseases that contribute to PAD.
If you take drugs to treat high blood pressure, it's important to take them
consistently and properly according to doctor and pharmacist instructions.
For diabetics, maintaining good blood sugar control is vital in helping to
ward off worsening PAD.
It's crucial to slow down the progress of PAD in order to limit its complications.
If your PAD continues and you need treatment, there are a few options, including
medications and surgical procedures.
Drugs used to treat PAD include aspirin* and clopidogrel.
These are blood thinners which help prevent PAD from worsening and also protect
against heart attacks and strokes. When arteries are blocked suddenly, it is
usually because of a blood clot - in this case, intravenous blood thinners such
as heparin can help improve blood flow in a hospital setting. Other medications
such as pentoxifylline or cilastozol may make it easier for oxygen to get to
the muscles.
An angioplasty can reopen blocked areas in the blood vessels. Your doctor
inserts a catheter (a small tube) into the affected artery and inflates and
deflates a small balloon repeatedly to widen the plaque. Angioplasty can only
be done if the artery hasn't yet hardened. The blockage also has to be over
just a small area of the artery and there can't be too many blocked areas along
the artery. During an angioplasty, you don't have to undergo general anesthesia,
and so the hospital stay is about a day. Drugs such as heparin or aspirin are given after the procedure to prevent blood clots from forming.
A stent or a small metal frame can be inserted into the artery in order to
support the artery walls after an angioplasty.
Bypass surgery might be necessary if other treatments don't work. The
surgeon takes a bypass graft - a tube made of a synthetic material or a vein
from another part of the body - and joins it to the artery above and below the
obstruction. Another approach is to remove the blocked or narrowed section and
insert a graft in its place. Sometimes, if the affected area is small enough,
the doctor might be able to cut the clot out and save the artery.
PAD can cause severe complications in the legs and feet. Because there's
less blood flowing to those parts of the body, the muscles and skin won't get
the nutrients they need. A cut, scrape, blister, or any other type of damage
to the skin may have a harder time healing. For this reason, it's very important
to take extra care of your feet if you have PAD.
Here is some advice to identify and prevent PAD.
- Look at your feet every day, especially around the time of bath or shower.
- Don't walk barefoot; it may cause small cuts or scrapes and promote infection
in cuts that may already be present.
- Use mild soap to wash your feet.
- Dry your feet thoroughly after washing and don't use skin creams unless
your doctor recommends them. Damp skin can break down easily and moisture
can trigger bacterial growth, causing an infection.
- Cut your toenails very carefully and straight across. You want to avoid
in-grown toenails.
- Wear comfortable shoes and watch carefully for blisters when you wear new
shoes. If you notice any cuts, blisters, or other problems, monitor them closely.
Ulcers should be covered with clean, dry dressings.
Be sure to contact your doctor if the cuts or ulcers don't seem to be healing
or get redder or bigger, change color, or develop a foul odor. The doctor
might prescribe an antibiotic in the form of an ointment or a pill. It can take
weeks or months for the antibiotics to cure an infected ulcer.
In rare cases, if a leg or foot infection is severe or gangrene develops, amputation
may be needed. But this is a last resort - most often, prompt and appropriate
treatment is enough to prevent the infection from spreading.
*All medications have both common (generic) and brand names. The brand name
is what a specific manufacturer calls the product (e.g., Tylenol®).
The common name is the medical name for the medication (e.g., acetaminophen).
A medication may have many brand names, but only one common name. This article
lists medications by their common names. For more information on brand names,
speak with your doctor or pharmacist.