Successful treatment of your peripheral artery disease (PAD) can make a significant difference in your life by
- reducing your risk of heart attack and stroke
- providing relief from pain and other symptoms that have been preventing you from doing the many things you used to enjoy
- save your legs and feet from serious infection, gangrene, and amputation
Spectrum of Care
The type of treatment you receive for PAD, as with cardiovascular disease in general, depends on your personal circumstances, the extent of disability and risk, and the nature of the problem.
If you have blockages in your arteries, your physician will assess the severity of your cardiovascular disease and where you best fit among a range of treatment options – sometimes referred to as the spectrum of care. The spectrum of care options for cardiovascular disease consist of a combination of treatments including --
- Lifestyle changes
- Revascularization, or treatment to re-establish blood flow through a narrowed artery. Options for revascularization include:
- Angioplasty and stenting and other interventional procedures
- Bypass surgery
Some patients may be at the beginning stages of cardiovascular disease. In this case, changing lifestyle elements such as diet and exercise might be enough to get you back on track for good health. For other patients, medication in addition to lifestyle changes can slow or reverse the progress of cardiovascular disease. For patients with more advanced disease, revascularization, in addition to medication and lifestyle changes may be necessary.
If you have an interventional cardiologist on your care team, he or she will work in conjunction with other healthcare providers to determine which treatment options are likely to benefit you most. These treatment decisions are based on education and experience, as well as being grounded in practice guidelines. Interventional cardiologists who treat PAD use the 2005 Practice Guidelines for the Management of Patients with Peripheral Arterial Disease jointly developed by the American Association for Vascular Surgery/Society for Vascular Surgery, Society for Cardiovascular Angiography and Interventions (SCAI), Society for Vascular Medicine and Biology, Society of Interventional Radiology, American College of Cardiology (ACC) and American Heart Association (AHA).
Throughout the decision-making process, the patient is also a core member of the care team. You can help your interventional cardiologist determine which treatment options make the most sense for you based on desired quality of life. Participating in your own care starts with something as simple as writing down questions you may have about the procedure and bringing that list to your next appointment. Your interventional cardiologist can work with you to find a truly individualized treatment.
One of the most common and effective forms of treatment for PAD is lifestyle changes. With your doctor’s guidance, habits of healthy living can improve your health and quality of life whether you have PAD or not (as long as you do them under a doctor’s guidance).
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What Lifestyle Changes Can I Make to Treat My Peripheral Artery Disease?
If you have PAD, just like diabetes, it will be treated by your doctor as if you already have coronary artery disease (CAD) because if you have one, there’s a good chance you have the other, too. So in addition to lifestyle changes, your doctor will probably prescribe medication even if you don’t currently have symptoms of CAD. Medication can help prevent serious cardiovascular events such as heart attack or strokes. If you have already had a heart attack or stroke, medication can help prevent further buildup of plaque in your arteries. Therefore, it is extremely important to take the medications as prescribed by your doctor.
If PAD causes the arteries in your legs to become clogged and narrowed to the point that blood flow cannot supply enough oxygen to your leg muscles, your physician may recommend angioplasty and stenting to restore blood flow to the muscles. When blood flow is restored, leg pain – and the risk of losing a leg or foot due to severe narrowing of the arteries – may be reduced.
There are many endovascular procedures that may be recommended for the treatment of PAD, but the two most common are angioplasty and stenting. These procedures are also commonly used to treat blocked arteries to the heart to restore blood flow and stop chest pain, or angina, halt a heart attack in its tracks, or lower the risk of heart attack or stroke. An endovascular procedure is performed by a doctor with special endovascular training. PAD can be treated by a number of specialists, including interventional cardiologists, vascular surgeons, interventional radiologists, and vascular medicine specialists.
Angioplasty and Stenting
Your interventional cardiologist or other vascular specialist may recommend angioplasty and stenting to open the blocked arteries and restore blood flow to your legs. Angioplasty is a procedure performed in the catheterization laboratory, or “cath lab,” in a hospital. You will lie on a table and be mildly sedated to help you relax, but you will remain awake throughout the procedure.
A thin flexible tube called a catheter is inserted into the artery and threaded through the arteries to the blockage. (Since there are no nerves in your arteries, you will not feel the catheter.) An x-ray camera and images of your arteries on a television screen help the physician guide the catheter to the blockage. A tiny, thin wire is then passed across the narrowed segment of the artery. It serves as a support for positioning the tiny balloon across the blockage.
Next a balloon catheter – a long, thin flexible tube with a small uninflated balloon at its tip – is threaded into the artery to where the artery is narrowed. Once in position, the balloon is inflated to open the artery and most cases place a metal mesh tube called a stent to hold the artery open and reduce the risk of the artery narrowing again. After the placement of the stent your doctor will remove all catheters.
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After Your Procedure
Most patients with PAD who are treated with angioplasty and stenting are released from the hospital 12 to 24 hours after the catheter is removed. Many patients are able to return to work within a few days to a week after a procedure. If your interventional procedure included insertion of a stent, your interventional cardiologist or other vascular specialist will provide prescriptions for blood-thinning drugs, such as aspirin and clopidogrel, typically for a month to a year. It is very important that you follow your doctor’s instructions for these medications. And even after you begin to feel better, you should never stop taking your medications at any time without speaking with your interventional cardiologist.
What to Expect at Home
After an interventional procedure, it is normal to:
Have a bruise or discolored area near where the catheter was inserted. At the same site, there may also be a small lump (which should not get bigger), soreness when pressure is applied and perhaps a small amount (one or two drops) of discharge.
When to call the doctor:
- If the puncture wound gets bigger, turns red, drains a thick yellow/brown material, or is painful, even when no pressure is applied. A larger, painful lump may be a sign that the puncture hole is not healing properly or is leaking blood.
- If you have fever.
- If you experience swelling – with or without pain – anywhere in the leg in which the catheter was inserted.
Resuming Normal Activities After Your Procedure
Always follow your doctor’s instructions about the activity level appropriate for you. Once you leave the hospital, your post-procedure care will be two-fold. You will need to take care of yourself by taking medication exactly as prescribed, as well as making lifestyle changes such as exercising, improving your diet, and quitting smoking if you smoke. You should also have at least one follow-up appointment with your treating interventional cardiologist or another qualified specialist if you are not able to return to your treating physician. At this appointment, your interventional cardiologist will examine the catheter insertion site to be sure it is healing properly.
If you would like to know more about angioplasty and stenting see Questions to Ask Your Interventional Cardiologist about Stents.
Surgery is another option for restoring blood flow to your legs, or in some cases arms. If a lengthy portion of an artery becomes narrowed – or if a vessel is severely blocked, bypass surgery may be recommended. Blood flow is restored by rerouting the blood around the blockage in an effort to reduce leg pain and the risk of losing a leg or foot due to severe narrowing of the arteries.
In bypass surgery, the surgeon makes an incision near the blocked artery, and then attaches a new blood vessel (from another part of the body or a synthetic vessel) above and below the blockage. By providing a channel for the blood to bypass the blockage, the new vessel, called a graft, allows blood to continue to flow to the leg and foot. Once the vessel is attached, the surgeon closes the incision with sutures or staples.
Bypass surgery is performed by a vascular surgeon, a medical specialist trained in surgical procedures to treat conditions affecting the heart and blood vessels. See “Care Team During Bypass” to learn more about members of the care team for surgery. The procedure is done in a hospital operating room.
Immediately after surgery, you will be monitored to ensure that blood is flowing to your legs and that your vital signs are good. You will be given medicine to control pain. After a few days when you are able to walk on your own, you will be released from the hospital.
After you leave the hospital, it is very important to take all the medications your doctor has prescribed and follow all instructions for caring for your incision. It is also vital that you make all your follow-up visits to the doctor to ensure that blood is flowing properly to your legs.
If the Pain Returns
Arteries can become blocked again after they have been treated. A re-narrowing of the artery, called restenosis, may cause you to experience leg or foot pain. If you feel pain after you have been treated, call your doctor. A second procedure may be needed to widen the artery again.
Questions to Ask Your Doctor about Bypass Surgery
Risks and Complications of Bypass Surgery
More than 95 percent of people who undergo bypass surgery do not experience serious complications. But, as with any surgery, risks do exist. They include:
- Death (occurs in 2 to 5 percent of cases)
- Heart attack (occurs in up to 3.4 percent of cases)
- Heavy bleeding and reactions to anesthesia, including difficulty breathing, symptoms that are common with other surgeries
- Blood clots
- Wound infection
- Need for additional surgery
The condition of your health at the time of bypass surgery can influence your risk and possible complications. Somewhat higher risk is associated with:
- Age: People over 70 years old
- Gender: Women are at slightly higher risk
- Previous heart surgery
- Other serious conditions, such as diabetes, peripheral vascular disease, kidney disease or lung disease
Treatment—Not a Cure
Remember, medication and procedures, such as angioplasty, stenting, and surgery do not cure PAD because we continue to accumulate plaque in our arteries throughout our lives. Arteries can become blocked again after they have been treated. A re-narrowing of the artery, called restenosis, may cause you to experience leg or foot pain again. If you feel pain after you have been treated, call your doctor. A second procedure may be needed to widen the artery again.