Treatment - Peripheral arterial disease (PAD)

There's no cure for peripheral arterial disease (PAD), but lifestyle changes and medicine 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
• heart attack

Treatment is very important, because having PAD is a sign that your blood vessels are unhealthy.

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

Lifestyle changes

The 2 most important lifestyle changes that you can make if you're 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. Exercise can also boost your self-esteem, mood, sleep quality and energy.

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 2 hours of supervised exercise a week for 3 months. Aim to exercise daily for the rest of your life, as the benefits of exercise are quickly lost if it's not frequent and regular.

One of the best exercises you can do is walking. It's normally recommended that you walk as far and as long as you can before the symptoms of pain become intolerable. Then rest until the pain goes. Begin walking again until the pain returns. Keep using this "stop-start" method until you've spent at least 30 minutes walking in total. Do this several times a week.

The exercise course is challenging, as the frequent episodes of pain can be upsetting. However, it should improve your symptoms.

Read about:

Benefits of exercise

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 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 their diagnosis.

Read more about stopping smoking.

Other lifestyle changes

As well as 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 balanced diet
• managing your weight
• cutting down on alcohol

Mental wellbeing

PAD can cause severe pain and disrupt your life. If you're dealing with depression or anxiety it's important to access support to look after your mental wellbeing.

Read about:

• How to be happier
• Anxiety, fear and panic

Diabetes

Having poorly controlled diabetes can also make your PAD symptoms worse and raise your chances of developing other forms of CVD.

It's important to manage your diabetes properly, which may involve lifestyle changes. These can include having a healthy, balanced diet and taking medicines to lower your blood sugar level.

Read about things to help if you're newly diagnosed with type 1 diabetes and understanding medicine for type 2 diabetes.

Medicines

Different medicines 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 1 or 2 of these medicines, while others may need to take several.

Statins

If blood tests show that your levels of LDL cholesterol ("bad cholesterol") are high, you'll 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 side effects, such as:

• indigestion
• headaches
• feeling sick (nausea)
• muscle aches

Antihypertensives

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

Read more about diagnosing high blood pressure.

A common type of antihypertensive is an angiotensin-converting enzyme (ACE) inhibitor, which blocks the actions of some hormones that help regulate blood pressure. This 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 for longer.

If your side effects become severe, a similar medicine called an angiotensin receptor blocker (ARB) may be recommended.

Medicines to prevent blood clots

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'll probably be prescribed a medicine to reduce your risk of blood clots. This medicine works by stopping platelets (a type of blood cell) from sticking together so your blood is less likely to clot.

Medicines you may be prescribed if you have PAD include:

• low-dose aspirin 
• clopidogrel 
• rivaroxaban

Naftidrofuryl oxalate

You may be offered naftidrofuryl oxalate if you have leg pain triggered by exercise (intermittent claudication).

This medicine may improve blood flow in the body, and is very occasionally used if you prefer not to have surgery. It may also be used if 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'll normally be advised to take naftidrofuryl oxalate for around 3 to 6 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 it prevents you from carrying out everyday activities, or if your symptoms have failed to respond to the treatments mentioned.

There are 2 main types of revascularisation treatment for PAD:

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

Which procedure is best?

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

An angioplasty is less invasive than a bypass. It does not involve making major cuts (incisions) in your body and is usually performed under local anaesthetic as a day procedure. This means you'll 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. This means the procedure may need to be repeated less often than an angioplasty.

Both angioplasty and bypass surgery carry a small risk of serious complications, such as a heart attack, stroke and even death. While there are not many studies comparing bypass surgery and angioplasty for PAD, there's some evidence to suggest that the risk of serious complications is similar in both.

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