There are three major options available:
- Discontinue cigarette smoking completely and permanently. This not only prevents the progression of the atherosclerosis, but also may improve walking tolerance.
- Begin a structured exercise program that includes walking on a treadmill or walking outside for about 30 to 40 minutes a day (rest when leg pain begins and resume walking when pain subsides).
- Begin medication. There are two drugs available in the United States: Pentoxifylline (Trental), which has been available for several years, and a drug called cilostazol (Pletal), which was approved in 1999. Cilostazol has been shown to be effective in increasing the walking distance in patients who have exertional calf discomfort. Your physician can tell you if either medication is right for you or in combination with exercise therapy or other treatments.
What other treatment options are available?
PAD can be treated with angioplasty alone or in combination with stenting, and with bypass surgery. In extreme cases (3-6%) amputation of the affected limb may be necessary.
How common is continued leg pain after a bypass?
It is quite common for claudication to persist after surgery but ideally this symptom should be less severe. This is because it is usually not possible for the surgeon to bypass all of the many blockages that exist in patients with PAD.. Recommended care and management is to embark on an exercise rehabilitation program in a supervised setting. Such a program usually involves treadmill walking at least three times a week. These programs are often administered by vascular specialists, or at the Vascular or Cardiac Rehab centers usually located in nearby hospitals. A vascular internist or cardiologist should supervise the care.
What treatment options are in development for PAD?
Multiple combination therapies have been proposed for the treatment of PAD including combinations of drug and laser therapy. Several trials of growth factors to grow new vessels have not yielded additional satisfactory treatments. If bypass and angioplasty are no longer options, eligibility for current trials should be considered.
For further information from the U.S. Department of Health and Human Services: www.aboutpad.org
Finding a Physician
The Society for Vascular Medicine and Biology will let you search their database of qualified vascular specialists. This website is located at http://www.svmb.org/directory.cgi
The Society of Cardiovascular and Interventional Radiology offers a service called "Find An Interventional Radiologist Near You" that can be found at this link: http://www.scvir.org/locate/index.htm
The American Association of Vascular Surgeons offers a service called "Find A Physician" that can be found at this link: http://www.vascularweb.org.
Sources
Drug Treatment of Peripheral Artery Disease. Available at: http://www.jr2.ox.ac.uk/bandolier/band29/b29-4.html.
Peripheral Artery Disease. Available at: http://www.understandingpad.com.
Vascular Disease Foundation, Peripheral Artery Disease. Available at: http://www.vdf.org.
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