Peripheral arterial disease - Treating peripheral arterial disease

There is no cure for peripheral arterial disease (PAD), but lifestyle changes and medication can help reduce the symptoms.

These treatments can also help reduce your risk of developing other types of cardiovascular disease (CVD), such as coronary heart disease, stroke and heart attack.

This is very important, because having PAD is a sign that your blood vessels are unhealthy, which can mean you are more likely to develop one of these potentially more serious problems.

Surgery may be used in severe cases or when initial treatment has not effectively reduced your symptoms.

Lifestyle changes

The two most important lifestyle changes that you can make if you are diagnosed with PAD are exercising more regularly and stopping smoking, if you smoke.

Exercise

Evidence suggests that regular exercise helps to reduce the severity and frequency of PAD symptoms, while also reducing the risk of developing another CVD.

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. 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.

One of the best exercises you can do is walking. It is normally recommended that 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 in total. This should ideally be repeated several times a week.

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 periods without experiencing pain.

Read more about health and fitness and walking for health.

Stop smoking

Stopping smoking will reduce your risk of PAD getting worse and another serious CVD developing.

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

Other lifestyle changes

In addition to exercising and stopping smoking, there are a number of other lifestyle changes you can make to reduce your risk of developing other forms of CVD.

These include eating a healthy diet, maintaining a healthy weight and cutting down on alcohol.

Medication

Different medications can be used to treat the underlying causes of PAD, while also 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.

Many people who take statins experience no or very few side effects, although others experience some troublesome – but usually minor – side effects, such as indigestion, headaches or feeling sick (nausea).

Antihypertensives

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

It's likely that 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 our page on diagnosing high blood pressure for more information about how blood pressure is measured.

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

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.

If you have PAD, 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 and clopidogrel are two antiplatelet medications often prescribed for people with PAD.

Common side effects of low-dose aspirin include indigestion and an increased risk of bleeding.

Common side effects of clopidogrel can include:

headaches or dizziness
feeling sick
diarrhoea or constipation
indigestion
stomach (abdominal) pain
an increased risk of bleeding

Naftidrofuryl oxalate

NICE recommends naftidrofuryl oxalate for the treatment of leg pain triggered by exercise (intermittent claudication) in people with PAD.

This medication may improve blood flow in the body, and is very occasionally 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 can include:

feeling sick
abdominal pain
diarrhoea
rashes

You will normally be advised to take naftidrofuryl oxalate for around three to six months, to see if it improves your symptoms. If the treatment is not effective after this time, it will be stopped.

Surgery and procedures

In a few cases, a procedure to restore the flow of blood through the arteries in your legs may be recommended. This is known as revascularisation.

Revascularisation may be recommended if your leg pain is so severe that it prevents you from carrying out everyday activities, or if your symptoms have failed to respond to the treatments mentioned above.

There are two main types of revascularisation treatment for PAD – angioplasty and a bypass graft. Both techniques are outlined below.

Angioplasty

Angioplasty is where a blocked or narrowed section of artery is widened by inflating a tiny balloon inside the vessel.

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 permanently to help keep the artery open.

For details on a similar procedure, read about coronary angioplasty.

Bypass graft

A bypass graft is where blood vessels are taken from another part of your body and used to bypass the blockage in an artery.

During the operation, 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 about a coronary artery bypass graft.

Which procedure is best?

You may not always be able to choose between having an angioplasty or a bypass graft, but if you are, it's important to be aware of the advantages and disadvantages of each technique.

An angioplasty is less invasive than a bypass (it doesn't involve making major incisions in your body) and 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, and you may recover more quickly.

For this reason, angioplasty is generally preferred to bypass surgery, unless angioplasty is not suitable or has failed previously.

However, the results of a bypass are generally considered to be longer-lasting than those of an angioplasty, and the procedure may therefore need to be repeated less often than an angioplasty may need to be.

Both angioplasty and bypass surgery carry a small risk of serious complications, such as a heart attack, stroke and even death. While there are few studies comparing the two techniques for PAD, there is some evidence to suggest that the risk of serious complications is similar in both bypass surgery and angioplasty.

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