Medical Therapy For PAD
Medical therapy is usually sufficient if you have relatively mild or moderate PAD. Medical therapy consists of risk factor modification, exercise training, and the use of anti-platelet drugs.
1) Risk Factor Modification. Optimizing your risk factors for atherosclerosis, using both lifestyle changes and medications, is very important if you have PAD. Risk factor modification can not only to slow the progression of your PAD, but also can prevent the worsening, or the development of, coronary artery disease (CAD). (The incidence of CAD is very high in patients with PAD.)
In particular, reducing your LDL cholesterol levels to below 100 mg/dL has been shown to reduce claudication (the pain or cramping, usually with exertion, that is caused by PAD). It is also important to stop smoking, control hypertension, and keep diabetes under good control.
2) Exercise Training. An exercise training program - usually a walking program - tailored by a physical therapist to your own specific condition can significantly reduce claudication and improve your ability to walk comfortably. Patients with claudication who follow such an exercise program can expect significant results within two months.
3) Anti-Platelet Drugs. Anti-platelet drugs (i.e., drugs that reduce clotting by interfering with the function of platelets, the blood elements that assist in blood clotting) have been shown to reduce the need for subsequent surgery, and also reduces the risk of heart attack. Furtermore, these drugs sometimes help reduce claudication. Virtually all patients with PAD should be on anti-platelet medication. The anti-platelet drugs used most often for PAD are aspirin and Plavix (clopidogrel).
In addition to these three "standard" medical therapies for PAD - all of which ought to be used in everyone with PAD - there are a few other medications that can help reduce the symptoms of claudication, and which can be used if symptoms remain despite the standard measures. These include Pletal (cilostazol) and Trental (pentoxifylline).
There is spotty evidence suggesting that ginkgo balboa may reduce symptoms of PAD, but studies with this unregulated herbal product have been inconclusive. Chelation therapy has been well-studied for the treatment of PAD, and is not effective.
When Is Invasive Treatment Used For PAD?Your doctor may recommend surgery or angioplasty if your claudication does not respond to medical treatment, if your claudication is particularly severe, or if the survival your affected limb is threatened by reduced blood flow (for instance, if you have developed ulcers, or gangrene).
If you need invasive treatment for PAD, angioplasty (sometimes with insertion of a stent) is generally the first choice, since it is often effective and is far less invasive than bypass surgery. However, depending on the location, number and extent of your blockages, angioplasty may not be feasible. In this case, surgical bypass grafting will probably be recommended. (The graft is fashioned from an artery or vein taken from somewhere else in the body.) Both angioplasty (when feasible) and bypass grafting are generally quite effective at restoring blood flow to the affected limb, and relieving symptoms of claudication.
Norgren, L, Hiatt, WR, Dormandy, JA, et al. Inter-Society Consensus for the Management of Peripheral Arterial Disease (TASC II). J Vasc Surg 2007; 45 Suppl S:S5.
Hirsch, AT, Haskal, ZJ, Hertzer, NR, et al. ACC/AHA 2005 Practice Guidelines for the management of patients with peripheral arterial disease (lower extremity, renal, mesenteric, and abdominal aortic): a collaborative report from the American Association for Vascular Surgery/Society for Vascular Surgery, Society for Cardiovascular Angiography and Interventions, Society for Vascular Medicine and Biology, Society of Interventional Radiology, and the ACC/AHA Task Force on Practice Guidelines (Writing Committee to Develop Guidelines for the Management of Patients With Peripheral Arterial Disease): endorsed by the American Association of Cardiovascular and Pulmonary Rehabilitation; National Heart, Lung, and Blood Institute; Society for Vascular Nursing; TransAtlantic Inter-Society Consensus; and Vascular Disease Foundation. Circulation 2006; 113:e463.