The two main goals in the treatment of PAD include (1) reducing the risk of heart attack and stroke, and (2) improving quality of life by easing the pain that occurs with walking. To achieve these goals, patients with PAD need regular medical follow-up with health care providers who are experienced in treating this condition. Table 1 lists key recommendations in the medical treatment of PAD.
A blood-thinning medication is usually prescribed to reduce the risk of heart attack and stroke. Aspirin is the most commonly used blood thinner. Clopidogrel may be prescribed, either instead of or in addition to aspirin. In certain cases, low-dose rivaroxaban may also be added to aspirin. A “statin” cholesterol-lowering medication (such as atorvastatin or rosuvastatin) should also be prescribed to reduce the risk of heart attack and stroke. More information on statins can be found in the Statin Patient Information Page.
Quitting smoking is essential. Many resources are available to help with smoking cessation including medications (varenicline or bupropion), nicotine replacement, counseling, and hotlines such as 1-800-QUIT-NOW (1-800-784-8669). More information is available in the Smoking Cessation Patient Information Page.
PAD treatment also includes controlling other risk factors such as high blood pressure and diabetes. A blood pressure medication called an ACE-inhibitor (such as ramipril or lisinopril) may be prescribed.
A supervised exercise program will improve the symptoms of pain in the legs with walking (claudication), allowing patients to walk farther. A structured program typically includes walking on a treadmill in a supervised setting at least three times per week. People with PAD should also walk at home for a total of at least 30 to 60 minutes every day. The usual prescription is called “Start/Stop” exercise: walk until the discomfort reaches a moderate level and then stop; wait until the discomfort goes away completely; and then start walking again.
In some cases, a medication called cilostazol may be prescribed to improve the claudication symptoms. For some patients with more severe PAD, the claudication symptoms may still cause problems in daily life, even after a few months of exercise and medications. Restoration of blood flow is necessary in more severe cases to relieve pain at rest or to heal a wound. To restore the blood flow, the first step is usually an angiogram. During this procedure, contrast (dye) is injected into the blood vessels and specialized X-rays are taken. Angioplasty with a balloon may be used to clear the blockages, and a metal strut called a stent may be inserted to prop open the vessel. If the balloon and stent procedure is not possible, then bypass surgery may be necessary.
*Ratchford EV, Evans NS. Vascular disease patient information page: Peripheral artery disease. Vasc Med 2014; 19: 218–220. https://doi.org/10.1177/1358863X14534803. Used with permission from Sage Publications.