Peripheral arterial disease - Treatment 

Treating peripheral arterial disease 

Staying active over 60

As we get older, exercise is incredibly important to our overall health. Active older people talk about how physical activity has enhanced their lives and experts give their advice.

Media last reviewed: 06/09/2013

Next review due: 06/09/2015

Peripheral arterial disease and diabetes

Having poorly-controlled diabetes increases your risk of PAD symptoms worsening and raises your chance of developing heart disease, stroke or having a heart attack.

If you have PAD and poorly-controlled diabetes, your treatment may involve:

  • making lifestyle changes, such as exercising more regularly and reducing the amount of sugar and fat in your diet
  • insulin injections, if you were not previously using them 

There are two main types of treatment used in the management of peripheral arterial disease (PAD).

These are:

  • making lifestyle changes to improve symptoms and reduce your risk of developing a more serious cardiovascular disease (CVD), such as coronary heart disease
  • taking medication to address the underlying cause of your PAD and reduce the risk of developing another CVD. For example, a statin can be used to lower your cholesterol levels

Surgery may be used in some cases. For example, if you experience pain in your leg while resting or if there is tissue loss. These treatment types are discussed in more depth below.

Lifestyle changes

The two most important lifestyle changes you can make if you are diagnosed with PAD are:

  • if you currently smoke, you should stop 
  • take regular exercise

Smoking

Quitting smoking will reduce your risk of PAD getting worse and another serious cardiovascular disease developing.

Research has found people who continue to smoke after receiving their diagnosis are five times more likely to have a heart attack and seven times more likely to die from a complication of heart disease than people who quit after receiving their diagnosis.

People who stop smoking usually notice an improvement in their symptoms and an improvement in their ankle brachial pressure index (ABPI) score.

Exercise

Evidence suggests regular exercise helps reduce the severity and frequency of PAD symptoms, while at the same time reducing the risk of developing another CVD.

Research has found that after six months of regular exercise, a person can:

  • walk for two to three times longer before experiencing pain
  • walk a lot further before experiencing pain
  • see a 20% improvement in their ABPI score

If you are diagnosed with PAD, it is likely you have not taken part in regular exercise for many years (although this is not true for everyone, such as previously fit people with type 1 diabetes).

The National Institute for Health and Care Excellence (NICE) recommends supervised exercise as one of the first steps for managing PAD. This may involve group exercise sessions with other people with CVD, led by a trainer.

The exercise programme usually involves two hours of supervised exercise a week for three months. But ideally, over time, you should be aiming to exercise daily for the rest of your life, as the benefits of exercise are quickly lost if it is not frequent and regular. 

The preferred exercise is walking. It is normally recommended you walk as far and as long as you can before the symptoms of pain become intolerable. Once this happens, rest until the pain goes and begin walking again until the pain returns. Keep using this "stop-start" method until you have spent at least 30 minutes walking.

You will probably find the exercise course challenging, as the frequent episodes of pain can be upsetting and off-putting. However, if you persevere, you should gradually notice a marked improvement in your symptoms and you will begin to go longer and longer without experiencing pain.

Read more about health and fitness and walking for health.

Medication

Different medications can be used to treat the underlying causes of PAD while reducing your risk of developing another CVD.

Some people may only need to take one or two of the medications discussed below, while others may need all of them.

Statins

If blood tests show that your levels of LDL cholesterol ("bad cholesterol") are high, you will be prescribed a type of medication called a statin.

Statins work by helping to reduce the production of LDL cholesterol by your liver.

Common side effects of statins include:

Antihypertensives

Antihypertensives are a group of medications used to treat high blood pressure (hypertension).

It is likely you will be prescribed an antihypertensive drug if your blood pressure is higher than 140/90mmHg if you do not have diabetes, or 130/80mmHg if you do have diabetes.

Read more about diagnosing high blood pressure.

A widely used type of antihypertensive is an angiotensin-converting enzyme (ACE) inhibitor.

ACE inhibitors block the actions of some hormones that help regulate blood pressure. They help to reduce the amount of water in your blood and widen your arteries, both of which will decrease your blood pressure.

Side effects of ACE inhibitors include:

  • dizziness
  • tiredness or weakness
  • headaches
  • a persistent dry cough

Most of these side effects pass in a few days, although some people find they have a dry cough a bit longer.

If side effects become particularly troublesome, a medication that works in a similar way to ACE inhibitors, known as an angiotensin-2 receptor antagonist, may be recommended.

ACE inhibitors can cause unpredictable effects if taken with other medications, including some over-the-counter ones, so check with your GP or pharmacist before taking anything in combination with this medication.

Read more about treating high blood pressure

Antiplatelets

One of the biggest potential dangers if you have atherosclerosis is a piece of fatty deposit (plaque) breaking off from your artery wall. This can cause a blood clot to develop at the site of the broken plaque.

If a blood clot develops inside an artery that supplies the heart with blood (a coronary artery) it can trigger a heart attack. Similarly, if a blood clot develops inside any of the blood vessels going to the brain, it can trigger a stroke.   

You will probably be prescribed an antiplatelet medication to reduce your risk of blood clots. This medication reduces the ability of platelets (tiny blood cells) to stick together, so if a plaque does break apart, you have a lower chance of a blood clot developing.

Low-dose aspirin (around 75mg a day) is usually recommended.

Common side effects of aspirin include:

  • irritation of the stomach or bowel
  • indigestion
  • nausea (feeling sick)

If you are unable to take aspirin (for example, if you have a history of stomach ulcers or you are allergic to aspirin), an alternative antiplatelet called clopidogrel can be used.

Side effects of clopidogrel include:

  • diarrhoea
  • pains in your stomach and bowel
  • nosebleeds
  • bruising
  • blood in your urine
  • blood in your stools

Naftidrofuryl oxalate

NICE recommends naftidrofuryl oxalate for the treatment of intermittent claudication if you have PAD.

Naftidrofuryl oxalate improves blood flow in the body, and is often used if you prefer not to have surgery or your supervised exercise programme has not led to a satisfactory improvement in your condition.

Side effects of naftidrofuryl oxalate include:

  • dizziness
  • headache
  • stomach pains
  • diarrhoea
  • rashes

Surgery

There are two main types of surgical treatment for PAD:

  • angioplasty – where a blocked or narrowed section of artery is widened by inflating a tiny balloon inside the vessel
  • bypass graft – where blood vessels are taken from another part of your body and used to bypass the blockage in an artery

Angioplasty vs bypass surgery

Both types of surgery have their own set of pros and cons.

An angioplasty is less invasive (it does not involve making major incisions in your body). It is usually performed under a local anaesthetic as a day procedure. This means you will be able to go home the same day you have the operation. You also feel less pain after an angioplasty. However, the improvement in symptoms varies from person to person and may only last for around 6-12 months.

Bypass surgery, which is usually only used when angioplasty is not suitable or has failed, has a longer recovery time (around two to three weeks). However, the improvement in symptoms usually lasts for longer than a year.

However, after two years, both techniques have broadly the same success rate of improving symptoms.

Both techniques carry a risk of causing serious complications such as a heart attack, stroke and even death. One study found that the risk of death for angioplasty was around one person in every 200, and the risk for bypass graft was slightly higher – around two to three people in every 100.

Before recommending treatment, a team of specialist surgeons, doctors and nurses will discuss the options with you – including the potential risks and benefits.

Surgery is not always successful in treating PAD and is usually only recommended under the following circumstances:

  • Your leg pain is so severe it prevents you from carrying out everyday activities.
  • Your symptoms have failed to respond to treatments discussed above.
  • The results of tests, such as ultrasound scans, show surgery is likely to improve symptoms.

Both techniques are discussed in more detail below.

Angioplasty

A tiny hollow tube known as a catheter is inserted into one of the arteries in your groin. The catheter is then guided to the site of the blockage.

On the tip of the catheter is a balloon which is inflated when the catheter is in place. This helps widen the blood vessel. Sometimes a metal mesh 'tube' known as a stent may be left in place to help keep the artery open.

Read more about angioplasty.

Bypass graft

If angioplasty is unsuccessful or unsuitable, a bypass graft may be performed. During surgery a length of healthy vein in your leg is removed. The vein is then joined (grafted) above and below the blocked vein so the blood supply can be rerouted, or bypassed, through the healthy vein. Sometimes a section of artificial tubing can be used as an alternative to a grafted vein.

For details on a similar operation, read more about a coronary artery bypass graft.




Page last reviewed: 30/08/2012

Next review due: 30/08/2014

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