Peripheral arterial disease

Treating peripheral arterial disease

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

  • 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 PAD and reduce your risk of developing another CVD. For example, a statin can be used to lower your cholesterol levels.

Surgery may be used as a last resort. 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, stop. 
  • Take regular exercise.

Smoking

Quitting 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 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 quit smoking usually notice an improvement in their symptoms and an improvement in their ankle brachial pressure index (ABPI) score.

It is recommended that you use an anti-smoking treatment such as nicotine replacement therapy (NRT) or bupropion (a medication used to reduce cravings for cigarettes). People who use these treatments have a much greater success rate in permanently quitting than people who try to quit using willpower alone.

If you want to quit smoking, it is a good idea to see your GP first. They can provide help and advice about quitting, and can refer you to an NHS Stop Smoking support service. These services offer the best support for people who want to give up smoking. Studies show you are four times more likely to quit smoking if you do it through the NHS.

Call the NHS Smokeline on 0800 84 84 84 or visit the Can Stop Smoking website.

Exercise

There is a lot of high-quality evidence showing that taking part in regular exercise helps to 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).

So it is usually recommended that you are referred for a course of group exercise sessions with other people with CVD, under the supervision of a trainer.

Each session should last at least 30–45 minutes and be performed at least three times a week for a minimum of 12 weeks. But ideally, over time, you should be aiming to exercise daily for the rest of your life.

The preferred exercise 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.

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

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 to take 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:

  • digestive disorders, such as constipation, diarrhoea, dyspepsia (acid in the stomach) and flatulence (passing wind)
  • headache
  • insomnia (difficulty sleeping)
  • myalgia (pain in the muscles)
  • arthralgia (pain in the joints)
  • nausea (feeling sick)

For more information, see the Health A-Z topic on Statins.

Antihypertensives

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

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. See High blood pressure – Diagnosis for more information on how blood pressure is measured.

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

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

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.

For more information, see the Health A-Z topic on High blood pressure – Treatment.

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 (usually 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
  • indigestion (dyspepsia)
  • pains in your stomach and bowel
  • nosebleeds
  • bruising
  • blood in your urine
  • blood in your stools

For more information, see the Health A-Z topics on Low-dose aspirin and Clopidogrel.

Cilostazol

If your symptoms of leg pain are severely disrupting your normal daily activities, you may be prescribed a medication called cilostazol.

Cilostazol reduces the ability of the blood to clot, while causing the arteries in the legs to expand, which should both help improve the blood supply to your legs.

However, cilostazol can potentially cause a wide range of side effects, which is why it is only used to treat the most problematic cases of PAD (although it would be unusual to experience any more than a few of these).

Common side effects of cilostazol include:

  • headache
  • diarrhoea
  • nausea
  • vomiting
  • swelling of your feet, ankles or face
  • rapid heartbeat
  • sore throat
  • dizziness
  • chest pain
  • itchy skin rash
  • indigestion and flatulence (burping and passing wind)

If you do feel dizzy when taking cilostazol, you should not drive or operate complex or heavy machinery.

Cilostazol is not recommended if you are pregnant or breastfeeding, and you should avoid getting pregnant if you are on this medication.

If you suspect that you have become pregnant when taking cilostazol, contact your GP for advice as soon as possible.

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

Both types of surgery have their own set of pros and cons (see box).

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

  • Your leg pain is so severe that you are essentially disabled as you are no longer able to walk any significant distance.
  • Your symptoms have failed to respond to the treatments discussed above.
  • The results of tests, such as ultrasound scans, show that surgery is likely to improve symptoms.

Both techniques are discussed in more detail below.

Angioplasty

An angioplasty is carried out under a local anaesthetic, which means you will be awake during the operation but your legs will be numbed by the anaesthetic, so you will not feel any pain.

The surgeon will insert a tiny hollow tube known as a catheter 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. Once the catheter is in place, the balloon is inflated, which helps widen the vessel. Sometimes a hollow metal tube known as a stent may be left in place to help keep the artery open.

For more information on this procedure, see the Health A-Z topic on Angioplasty.

Bypass graft

A bypass graft is performed under a general anaesthetic, which means you will be asleep during surgery and you will not experience any pain.

During surgery the surgeon will remove a small section of a healthy vein in your leg. The vein is then grafted (joined) onto 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 more information on this procedure, see the Health A-Z topic on Coronary artery bypass graft.

Last updated: 30 October 2012

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