Medication
Treatment for peripheral artery disease (PAD) focuses on reducing symptoms and preventing further progression of the disease. In most cases, lifestyle changes, exercise and claudication medications are enough to slow the progression or even reverse the symptoms of PAD. View our interactive library to learn more about PAD.
Procedures
The good news is that like other diseases related to the arteries, PAD can be treated by making lifestyle changes, taking medicines, or undergoing leg artery angioplasty or other endovascular intervention type procedures (laser, stents, atherectomy, rotational atherectomy, etc.) or traditional vascular surgery, if needed. You can live well with PAD
Self-care
Quitting smoking will help slow the progression of PAD and other heart-related diseases. Learn how you can kick the habit on our Quitting Smoking website. An effective treatment for PAD symptoms is regular physical activity. Your doctor may recommend supervised exercise training, also known as supervised exercise therapy (SET).
Nutrition
PAD has a higher risk of death than certain well-known cancers such as breast cancer, prostate cancer, and Hodgkin’s disease. When the blood flow to the legs is greatly (or severely) reduced, people with PAD may have pain when walking.
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How is peripheral artery disease (PAD) treated?
What is the best treatment for pad?
How can I slow the progression of pad?
What is the prognosis of pad?
When does a PAD need surgery?
Surgery is reserved for patients who have the most severe symptoms and complications. In the most extreme cases, when a leg has gangrene (when body tissue dies) and cannot be saved, amputation may be recommended. This is, however, a last resort and in many cases even when gangrene is present, amputation can be avoided.
When should you see a doctor for PAD?
Signs You Should See a Doctor for PAD Pain or cramping in the arms or legs, especially if it's more acute with physical activity and goes away with rest. Numbness or weakness in the legs. Cramping or pain in one or both of your thighs, hips, or calf muscles. Non-healing wounds or sores on the feet, toes, or legs.
What are the stages of peripheral vascular disease?
Fontaine classification10GradeSymptomsStage IAsymptomatic, incomplete blood vessel obstructionStage IIMild claudication pain in limbStage IIAClaudication at a distance > 200 mStage IIBClaudication at a distance < 200 m2 more rows
What is the prognosis for someone with PAD?
Prognosis is generally good with treatment, although mortality rate is relatively high because coronary artery or cerebrovascular disease often coexists.
What is considered severe PAD?
Patients with an ABI of 0.41 to 0.90 are considered to have mild to moderate PAD, and patients with an ABI ≤0.40 are considered to have severe PAD.
What are three signs symptoms that can accompany peripheral vascular artery disease?
What are the symptoms of peripheral vascular disease?Changes in the skin, including decreased skin temperature, or thin, brittle, shiny skin on the legs and feet.Weak pulses in the legs and the feet.Gangrene (dead tissue due to lack of blood flow)Hair loss on the legs.Impotence.More items...
What is stage 4 peripheral artery disease?
Stage IV – Ischaemic ulcers or gangrene (which may be dry or humid) [2]. The Rutherford classification describes seven stages of peripheral artery disease: Stage 0 – Asymptomatic.
What is the difference between peripheral vascular disease and peripheral artery disease?
It's pretty simple, actually: Peripheral artery disease (PAD) is the name of one specific disease, a condition that affects only arteries, and primarily the arteries of the legs. Peripheral vascular disease (PVD) is a generic “umbrella term” that describes a large number of circulatory diseases.
Can you live a long life with peripheral artery disease?
You can still have a full, active lifestyle with peripheral artery disease, or PAD. The condition happens when plaque builds up in your arteries. This makes it harder for your arms, legs, head, and organs to get enough blood. Although it's serious and can sometimes be painful, there are lots of ways to slow it down.
Is PAD a death sentence?
Both conditions are life-threatening, and yes, can result in death. Peripheral artery disease in the lower body is often a warning sign. There can be a similar buildup of plaque in other arteries, such as the ones that supply the heart or the brain.
Is PAD a serious condition?
PAD is a serious condition that should be diagnosed promptly so doctors can reduce your risk as quickly as possible. PAD may be your first warning sign of a serious health problem. Atherosclerosis—or clogging—in the peripheral arteries is dangerous.
How long can you live with intermittent claudication?
Of those who have the symptoms of intermittent claudication over a five-year period around 5-10 per cent will develop critical limb ischaemia, the most severe form of PAD. With critical limb ischaemia the outlook is poor – half of patients are likely to die within five years.
What is the goal of PAD therapy?
The goals of PAD therapy depend on the severity of the disease. For all patients with symptomatic or asymptomatic PAD, reducing the risk of cardiovascular morbidity and mortality is a primary concern. For patients with IC, improving functional status is an additional goal.
What is the ABI of a PAD?
Several tests are available to diagnose PAD. The initial test of choice includes the simple ABI measurement. Patients with an ABI of 0.41 to 0.90 are considered to have mild to moderate PAD, and patients with an ABI ≤0.40 are considered to have severe PAD. Similarly, an ABI >1.30 is abnormal and requires further testing. Data have shown an inverse relationship between baseline ABI and the risk of ischemic events (myocardial infarction, stroke, or cardiovascular death), such that as the ABI decreases, the risk of ischemic events increases. 12,13 Similarly, mortality increases with an ABI >1.30. If an ABI measurement at rest or at exercise is suggestive of PAD, further noninvasive testing is usually performed to characterize the anatomic location and severity of the disease; such testing includes segmental pressure measurements, pulse-volume recordings, exercise ABI, duplex ultrasonography, computed tomography angiography, and magnetic resonance angiography.
How long does claudication last?
In 5 to 10 percent of cases, claudication progresses to a worsened severity of the disease, called critical limb ischemia (CLI)—defined as ischemic rest pain for more than 14 days, ulceration, or tissue loss/gangrene.
How to improve functional status in intermittent claudication?
There are three main treatment options for improving functional status in patients with intermittent claudication: exercise training, medical therapy, and revascularization. Questions about comparative effectiveness include whether one approach is better than the other and whether certain combinations of them are most effective.
What is tibioperoneal intervention?
Tibioperoneal, or below-knee, endovascular interventions are typically reserved for patients with limb-threatening ischemia; however, multiple reports describe the adoption of tibioperoneal intervention for severe claudication.
How to treat PAD?
Interventional Radiology Treatments for PAD 1 Angioplasty: A tiny balloon is placed in the blood vessel at the site of the blockage. It is then inflated to open the blood vessel. 2 Stents: A tiny metal cylinder, or stent, is inserted in the clogged vessel to act like a scaffolding and hold it open. 3 Thrombolytic therapy: This treatment is implemented by an interventional radiologist if the blockage in the artery is caused by a blood clot. Thrombolytic drugs, sometimes called "clot busters", dissolve the clot and restore blood flow. Usually, the drugs are administered through a catheter directly into the clot. These drugs are frequently combined with another treatment, such as angioplasty. 4 Stent-grafts: A stent covered with synthetic fabric is inserted into the blood vessels to bypass diseased arteries.
What is PAD in medical terms?
PAD is sometimes called peripheral vascular disease, or PVD. Many people also refer to the condition as "hardening of the arteries.". This interferes with the normal flow of blood, sometimes causing pain but often causing no symptoms at all.
What is the treatment for a clogged vessel?
Stents: A tiny metal cylinder, or stent, is inserted in the clogged vessel to act like a scaffolding and hold it open. Thrombolytic therapy : This treatment is implemented by an interventional radiologist if the blockage in the artery is caused by a blood clot.
Why does PAD go undiagnosed?
Unfortunately, the disease often goes undiagnosed because many people do not experience symptoms in the early stages of PAD or they mistakenly think the symptoms are a normal part of aging.
What is the most common symptom of PAD?
What are the symptoms of PAD? The most common symptom of PAD is painful cramping in the leg or hip, particularly when walking. This symptom, also known as "claudication," occurs when there is not enough blood flowing to the leg muscles during exercise. The pain typically goes away when the muscles are given a rest.
Can you have gangrene if you have PAD?
People with PAD also may experience a cooling or color change in the skin of the legs or feet, or loss of hair on the legs. In extreme cases, untreated PAD can lead to gangrene, a serious condition that may require amputation of a leg, foot or toes. If you have PAD, you are also at higher risk for heart disease and stroke.
Who is at the highest risk for PAD?
The disease affects everyone, although men are somewhat more likely than women to have PAD. Those who are at highest risk are: Over the age of 50. Smokers. Diabetic. Overweight. People who do not exercise, or people who have high blood pressure or high cholesterol.
What happens if you have a PAD?
If you have PAD, you are at risk for developing coronary artery disease and cerebrovascular disease, which could lead to a heart attack or stroke. 4. The image on the left shows a normal artery. The right shows an artery narrowed by atherosclerosis, causing PAD.
How do you know if you have a PAD?
The classic symptom of PAD is pain in the legs with physical activity, such as walking, that gets better after rest. However, up to 4 in 10 people with PAD have no leg pain. 1 Symptoms of pain, aches, or cramps with walking (claudication) can happen in the buttock, hip, thigh, or calf. 2.
What are the risks of PAD?
Smoking. High blood pressure. Atherosclerosis. Diabetes. High cholesterol. Age above 60 years. Both men and woman are affected by PAD; however, African Americans have an increased risk of PAD. Hispanics may have similar to slightly higher rates of PAD compared with non-Hispanic white people.
How many people have PAD?
Approximately 6.5 million people age 40 and older in the United States have PAD. 1. Other health conditions and disorders of arteries can mimic the symptoms of PAD, and not all PAD is due to atherosclerosis. 2,3.
What is the blood pressure test for PAD?
If you have symptoms of PAD, your doctor may do an ankle brachial index (ABI), which is a noninvasive test that measures the blood pressure in the ankles and compares it with the blood pressure in the arms at rest and after exercise.
Does smoking cause PAD?
Smoking increases the risk of PAD and makes PAD symptoms worse. 4. Control high blood pressure and manage high blood cholesterol and diabetes. If you have PAD, participating in supervised exercise training programs can improve and prolong your ability to walk longer distances.
How to improve PAD?
Some of these include: Getting more physical activity. Eating a healthier diet.
What are the symptoms of PAD?
One leg that is cooler than the other. Cold or numb toes. Poor toenail growth. We want you to understand that not everyone experiences PAD or PAD symptoms in the early stages. In other words, you can have Peripheral Artery Disease or another vascular condition, but not realize it.
Where does peripheral artery disease affect the body?
While Peripheral Artery Disease symptoms most commonly affect the legs, it can also impact the arms. It is also important to note that many PAD symptoms occur in the legs, buttocks, thighs, and calves during activity. We want you to understand that not everyone experiences PAD or PAD symptoms in the early stages.
Can peripheral artery disease cause a stroke?
When left untreated, Peripheral Artery Disease can eventually limit mobility, necessitate leg amputation, or cause a life-threatening stroke or heart attack. You should also be aware that PAD symptoms tend to worsen over time.
What is PAD in a patient?
Patients with peripheral arterial disease (PAD) have decreased lower extremity arterial perfusion which is commonly referred to as “poor circulation.”. In most cases of PAD, atherosclerotic plaques narrow the arterial flow lumen which restricts blood flow to the distal extremity. Reduced blood flow can cause thigh or calf pain with walking due ...
What is PAD in surgery?
Others may develop limb-threatening compromise of blood flow, necessitating emergent surgery. Patients with peripheral arterial disease (PAD) have decreased lower extremity arterial perfusion which is commonly referred to as “poor circulation.”. In most cases of PAD, atherosclerotic plaques narrow the arterial flow lumen which restricts blood flow ...
What is PAD in aorta?
Pathophysiology. PAD usually involves atherosclerotic disease in the abdominal aorta, iliac, and femoral arteries. The pathophysiology of atherosclerosis involves complex interactions between cholesterol and vascular cells the details of which are beyond the scope of this article.
What is the most common symptom of PAD?
The most characteristic symptom of PAD is claudication which is a pain in the lower extremity muscles brought on by walking and relieved with rest. Although claudication has traditionally been described as cramping pain, some patients report leg fatigue, weakness, pressure, or aching.
How long does it take for cilostazol to work?
Patients who respond to cilostazol usually notice a positive effect within 12 weeks. Since cilostazol is a phosphodiesterase type-3 inhibitor, a history of congestive heart failure precludes patients from receiving this type of therapy.
What is peripheral arterial disease?
Continuing Education Activity. Peripheral arterial disease (PAD) is a circulatory problem causing a reduced blood flow through the arteries. This typically reduces blood flow to the extremities manifesting as thigh or calf pain during walking or exertion.
Why do lower extremities require increased blood flow?
The muscles of the lower extremity require increased blood flow during ambulation to meet the increased energy demand. Patients with PAD reach a point during walking at which collateral blood flow is maximized and cannot provide any more perfusion to the lower extremity muscles.
How to get rid of PAD symptoms?
They may suggest exercise plans that have been shown to curb PAD symptoms. Try to get 30 minutes of activity several times a week after your appointment. Choose exercises you enjoy, so you’ll stick with them.
How to reverse PAD?
Start with these tips for exercise, foot care, eating well, and more. 1. Walk and Rest. Because of your pain, you may be cutting back on activity. But you need to exercise when you have PAD.
How to stop leg pain from walking?
There are ways to do your workouts and control the pain. First of all, listen to your body and learn when to pause. If your legs bother you on a stroll, take a break. Wait for the pain to fade and begin again. By resting then starting again, you’ll build up your body. Start slowly but don’t give up.
Can compression socks cause PAD?
It’s best to skip compression socks. They don’t help with PAD and can actually cause more harm. If you wear them to prevent swelling or blood clots, check with your doctor to see whether they’re still a good idea. Check your feet and toes every day for sores, cracks, or anything that doesn’t look right.
Can you walk with PAD?
Your doctor may also be able to help you ease into a routine and work up to the amount of activity you need. They know it isn’t easy to move around with PAD.
Can you have a full life with peripheral artery disease?
You can still have a full, active lifestyle with peripheral artery disease, or PAD. The condition happens when plaque builds up in your arteries. This makes it harder for your arms, legs, head, and organs to get enough blood. Although it’s serious and can sometimes be painful, there are lots of ways to slow it down.
Is a PAD good for you?
It also helps to lower your blood pressure and “bad” cholesterol levels. And it’s good for your heart and just about every part of your body. 3. Take Care of Your Feet and Legs. People feel PAD most often in their legs, especially the calves or thighs. When blood can’t flow freely, you may feel pain or numbness.
What is the age of PAD?
PAD is a serious disease commonly affecting 1/3 of Americans over the age of 50. The hardened arteries found in people with PAD are a sign that they are likely to have hardened and narrowed arteries to the heart and the brain.
Where does PAD occur?
PAD occurs most often in the arteries in the legs, but it also can affect other arteries that carry blood outside the heart. This includes arteries that go to the aorta, the brain, the arms, the kidneys and the stomach.
What is a PAD?
PAD is short for Peripheral Arterial Disease. The term PAD encompasses a large series of disorders that affect arterial beds exclusive of the coronary arteries. People have PAD. when the arteries in their legs become narrowed or clogged with fatty deposits, or plaque. The buildup of plaque causes the arteries to harden and narrow, ...
How to control blood pressure with pletal?
Follow a healthy eating plan to control your blood pressure, cholesterol, and blood glucose (for diabetes). Get regular exercise such as walking for 30 minutes at least 3 or 4 times per week.
What are the symptoms of PAD?
The most common signs of PAD include one or more of these problems: Cramps, tiredness, or pain in your legs, thighs, or buttocks— that always happens when you walk, but that goes away when you rest. This is called claudication. Foot or toe pain at rest often disturbs your sleep.
How many people have peripheral artery disease?
According to the U.S. Centers for Disease Control and Prevention (CDC), approximately 18 million people in the United States suffer from Peripheral Artery Disease (PAD), a common circulatory problem in which plaque builds up in the arteries that carry blood to your head, organs, and limbs. Over time, plaque can harden and narrow ...
What is the best test to check for P.A.D?
If your provider finds those pulses are weak and thinks you may have P.A.D., your provider may order a test called the ABI, which stands for ankle-brachial index. The ABI is the best test for finding out if you have P.A.D.
Background and Objectives For The Systematic Review
The Key Questions
Analytic Framework
Methods
Specialist to consult
References
- Epidemiology of Peripheral Artery Disease
Peripheral artery disease (PAD) is the preferred clinical term for describing stenosis or occlusion of upper- or lower-extremity arteries due to atherosclerotic or thromboembolic disease.1However, in practice, the term PAD generally refers to chronic narrowing or blockage (also referred to as a… - Diagnostic Tests
Several tests are available to diagnose PAD. The initial test of choice includes the simple ABI measurement. Patients with an ABI of 0.41 to 0.90 are considered to have mild to moderate PAD, and patients with an ABI ≤0.40 are considered to have severe PAD. Similarly, an ABI >1.30 is abn…
Definition of Terms
- The draft key questions (KQs) developed during Topic Refinement were available for public comment from October 7, 2011, to November 3, 2011. Based on comments received in response to this posting, the following changes were made to the KQs: 1. Inclusion of symptomatic patients with atypical leg symptoms in KQs 1 and 2 2. Expansion of outcome measures for both KQ 2 an…
Review of Key Questions
- Draft analytic framework for treatment strategies for PAD Abbreviations: KQ = key question; PAD = peripheral artery disease
Key Informants
- In developing this comprehensive review, we will apply the rules of evidence and formulation of strength of evidence recommended by the Agency for Health Care Research and Quality (AHRQ) in its Methods Guide for Effectiveness and Comparative Effectiveness Reviews (hereafter referred to as the Methods Guide).42We will solicit feedback regarding design of the review (such as dev…
Technical Experts
- Hiatt WR, Goldstone J, Smith SC Jr, et al; American Heart Associaton Writing Group 1. Atherosclerotic Peripheral Vascular Disease Symposium II: nomenclature for vascular diseases. Circulation 2008;...
- Hirsch AT, Haskal ZJ, Hertzer NR, et al. ACC/AHA 2005 Practice Guidelines for the Management of Patients With Peripheral Arterial Disease (Lower Extremity, Renal, Mesenteri…
- Hiatt WR, Goldstone J, Smith SC Jr, et al; American Heart Associaton Writing Group 1. Atherosclerotic Peripheral Vascular Disease Symposium II: nomenclature for vascular diseases. Circulation 2008;...
- Hirsch AT, Haskal ZJ, Hertzer NR, et al. ACC/AHA 2005 Practice Guidelines for the Management of Patients With Peripheral Arterial Disease (Lower Extremity, Renal, Mesenteric, and Abdominal Aortic):...
- Hirsch AT, Criqui MH, Treat-Jacobson D, et al. Peripheral arterial disease detection, awareness, and treatment in primary care. JAMA 2001;286(11):1317-24. PMID: 11560536.
- Meijer WT, Hoes AW, Rutgers D, et al. Peripheral arterial disease in the elderly: the Rotterdam Study. Arterioscler Thromb Vasc Biol 1998;18(2):185-92. PMID: 9484982.
Peer Reviewers
- ABI ankle-brachial index ACC American College of Cardiology ACE angiotensin-converting enzyme AHA American Heart Association CLI critical limb ischemia IC intermittent claudication KQ key question PAD peripheral artery disease RCT randomized controlled trial