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Peripheral vascular disease treament

There are two main types of treatment used in the management of peripheral vascular disease (PVD):

  • making lifestyle changes to improve symptoms and reduce your risk of developing a more serious cardiovascular disease (CVD), such as coronary heart disease
  • taking medicine to address the underlying cause of PVD and reduce your risk of developing another cardiovascular disease. For example, a statin can be used to lower your cholesterol levels.

Surgery may be used as a last resort. These treatment types are discussed in more depth below.

Lifestyle changes

The two most important lifestyle changes you can make if you are diagnosed with PVD are outlined below:

Smoking cessation

If you currently smoke, stop.

  • It is recommended that you use an anti-smoking treatment such as nicotine replacement therapy (NRT) or bupropion (a medicine used to reduce cravings for cigarettes). People who use these treatments have a much greater success rate in permanently quitting than people who try to quit using willpower alone.
  • If you want to quit smoking, it is a good idea to see your doctor first. They can provide help and advice about quitting, and can refer you to a Stop Smoking support service. Quit Now can provide more information through their website or by calling their information line on 13 7848.

Exercise

There is a lot of high-quality evidence showing that taking part in regular exercise helps to reduce the severity and frequency of PVD symptoms, while at the same time reducing the risk of developing another cardiovascular disease.

Research has found that after six months of regular exercise, a person can:

  • walk for longer and further before experiencing pain
  • see an improvement in their ABPI score.

The preferred exercise is walking. It is normally recommended that you walk as far and as long as you can before the symptoms of pain become intolerable. Once this happens, rest until the pain goes and begin walking again until the pain returns. Keep using this 'stop-start' method until you have spent at least 30 minutes walking.

You will probably find the exercise course challenging, as the frequent episodes of pain can be upsetting and off-putting. But if you persevere, you should gradually notice a marked improvement in your symptoms and you will begin to go longer and longer without experiencing any pain.

Medicines

Different medicines can be used to treat the underlying causes of PVD while reducing your risk of further developing CVD.

Some people may only need to take one or two of the medicines discussed below, while others may need to take all of them.

Statins

If blood tests show that your levels of LDL cholesterol ('bad cholesterol') are high, you will be prescribed a type of medicine called a 'statin'.

Statins work by helping to reduce the production of LDL cholesterol by your liver.

Common side effects of statins include:

  • digestive disorders, such as constipation, diarrhoea, dyspepsia (acid in the stomach) and flatulence (passing wind)
  • headache
  • insomnia (difficulty sleeping)
  • myalgia (pain in the muscles)
  • arthralgia (pain in the joints)
  • nausea (feeling sick).

Antihypertensives

Antihypertensives are a group of medicines used to treat high blood pressure.

It is likely you will be prescribed an antihypertensive drug if your blood pressure is higher than 140/90mmHg if you do not have diabetes, or 130/80mmHg if you do have diabetes.

A widely used type of antihypertensive is an angiotensin-converting enzyme (ACE) inhibitor.

ACE inhibitors block the actions of some of the hormones that help to regulate blood pressure. They help to reduce the amount of water in your blood and widen your arteries, which will both 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 that they still have a dry cough.

If side effects become particularly troublesome, a medicine that works in a similar way to ACE inhibitors, known as an 'angiotensin-2 receptor antagonist', may be recommended.

ACE inhibitors can cause unpredictable effects if taken with other medicines, including some over-the-counter ones, so check with your doctor or pharmacist before taking anything in combination with this medicine.

Antiplatelets

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.

You will probably be prescribed an antiplatelet medicine to reduce your risk of blood clots. This medicine reduces the ability of platelets (tiny blood cells) to stick together, so if a plaque does break apart, you have a lower chance of a blood clot developing.

Low-dose aspirin (usually 75mg a day) is usually recommended.

Common side effects of aspirin include:

  • irritation of the stomach or bowel
  • indigestion
  • nausea (feeling sick).

If you are unable to take aspirin (for example, if you have a history of stomach ulcers or you are allergic to aspirin), an alternative antiplatelet called 'clopidogrel' may be used.

Cilostazol

Cilostazol reduces the ability of the blood to clot, while causing the arteries in the legs to expand, which should both help improve the blood supply to your legs.

However, cilostazol can potentially cause a wide range of side effects, which is why it is only used to treat the most problematic cases of PVD (although it would be unusual to experience any more than a few of these side effects).

Common side effects of cilostazol include:

  • headache
  • diarrhoea
  • nausea
  • vomiting
  • swelling of your feet, ankles or face
  • rapid heartbeat
  • sore throat
  • dizziness
  • chest pain
  • itchy skin rash
  • indigestion and flatulence (burping and passing wind).

If you do feel dizzy when taking cilostazol, you should not drive or operate complex or heavy machinery.

Cilostazol is not recommended if you are pregnant or breastfeeding.

Procedures

Bypass grafting – this surgery is done if the blood flow in your leg is obstructed. In this procedure, a graft (blood vessel taken from another part of your body or an artificial tube) is placed to bypass the blood flow around the blockage.

Angioplasty and stenting – angioplasty is a procedure done to restore blood flow through a blocked artery. It involves passage of a catheter with a deflated balloon at its tip into a blocked artery. The balloon is then inflated in order to displace the plaque outwards. This restores the blood flow by widening the artery. In addition, a stent may be placed in the artery to keep it open after angioplasty is done.

Source: NHS Choices, UK (Treating peripheral arterial disease)

Last reviewed: September 2015

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