Treatment
Dependent on the severity of the disease, the following steps can be taken:
- Smoking cessation (cigarettes promote PVD and are a risk factor for cardiovascular disease).
- Management of diabetes.
- Management of hypertension.
- Management of cholesterol, and medication with antiplatelet drugs. Medication with aspirin, clopidogrel and statins, which reduce clot formation and cholesterol levels, respectively, can help with disease progression and address the other cardiovascular risks that the patient is likely to have.
- Regular exercise for those with claudication helps open up alternative small vessels (collateral flow) and the limitation in walking often improves. Treadmill exercise (35 to 50 minutes, 3 to 4 times per week) has been reviewed as another treatment with a number of positive outcomes including reduction in cardiovascular events and improved quality of life.
- Cilostazol or pentoxifylline treatment to relieve symptoms of claudication.
Treatment with other drugs or vitamins are unsupported by clinical evidence, "but trials evaluating the effect of folate and vitamin B-12 on hyperhomocysteinaemia, a putative vascular risk factor, are near completion".
After a trial of the best medical treatment outline above, if symptoms remain unnacceptable, patients may be referred to a vascular or endovascular surgeon; however, "No convincing evidence supports the use of percutaneous balloon angioplasty or stenting in patients with intermittent claudication".
- Angioplasty (PTA or percutaneous transluminal angioplasty) can be done on solitary lesions in large arteries, such as the femoral artery, but angioplasty may not have sustained benefits.
- Plaque excision, in which the plaque is scraped off of the inside of the vessel wall.
- Occasionally, bypass grafting is needed to circumvent a seriously stenosed area of the arterial vasculature. Generally, the saphenous vein is used, although artificial (Gore-Tex) material is often used for large tracts when the veins are of lesser quality.
- Rarely, sympathectomy is used - removing the nerves that make arteries contract, effectively leading to vasodilatation.
- When gangrene of toes has set in, amputation is often a last resort to stop infected dying tissues from causing septicemia.
- Arterial thrombosis or embolism has a dismal prognosis, but is occasionally treated successfully with thrombolysis.
Read more about this topic: Peripheral Vascular Disease
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