How is peripheral artery disease (PAD) treated?

Peripheral artery disease (PAD) is usually treated by aggressively managing the risk factors with lifestyle changes and medication. This includes quitting smoking, controlling blood pressure and cholesterol, controlling diabetes and losing weight. In addition, a walking program, if followed faithfully, can significantly improve the symptoms of PAD in many cases. This means patients can take on a role of active participation in their health, possibly even avoiding surgical procedures.

If PAD is causing serious symptoms that cannot be changed by lifestyle modification, further treatments such as using a balloon or stent in the artery that is blocked can be very effective in improving the blood flow to the affected leg.

People with peripheral arterial disease (PAD) are at very high risk for heart attacks and stroke, so it is very important to manage cardiovascular risk factors. Here are some steps you can take:

  • Quit smoking. Your health care provider can help you.
  • Aim for an A1C below 7 percent. The A1C test measures your average blood glucose (sugar) over the past 2 to 3 months.
  • Lower your blood pressure to less than 130/80 mmHg.
  • Get your LDL cholesterol below 100 mg/dl.

Talk to your healthcare provider about taking aspirin or other antiplatelet medicines. These medicines have been shown to reduce heart attacks and strokes in people with PAD.

Studies have found that exercise, such as walking, can be used both to treat PAD and to prevent it. Medications may help relieve symptoms.

In some cases, surgical procedures are used to treat PAD:

  • Angioplasty, also called balloon angioplasty: a procedure in which a small tube with a balloon attached is inserted and threaded into an artery; then the balloon is inflated, opening the narrowed artery. A wire tube, called a stent, may be left in place to help keep the artery open.
  • Artery bypass graft: a procedure in which a blood vessel is taken from another part of the body and is attached to bypass a blocked artery.
Dr. David B. Marmor, MD
Cardiologist (Heart Specialist)

First and foremost, treat the risk factors for atherosclerosis. People with peripheral artery disease (PAD) are at substantially higher risk of heart attacks and stroke, so you need to be very aggressively treated to control cholesterol and blood pressure. You will also be given antiplatelet medicines. There are medications that are effective for reducing PAD symptoms, but probably the most effective intervention for symptoms improvement is a supervised exercise program. If symptoms are severe or life threatening (such as leg gangrene), we get more aggressive about revascularizing blood vessels through angioplasty or lower extremity bypass surgery.

Treatment of peripheral artery disease is similar to treatment of carotid artery disease and coronary artery disease. To prevent these diseases we have to give up tobacco use, control blood sugar, have diabetes completely under control, lipids within perfect range and decreased amounts of inflammation. There are mechanical treatments for peripheral artery disease such as angioplasty, placing a balloon to open the artery, as well as rotational aserectomy or stent placement. Additional treatments may include medication, supplements and even surgery.

There are a variety of new endovascular treatments for peripheral arterial disease affecting circulation to the legs. These include a range of techniques, from angioplasty and stent placement to atherectomy and other new techniques that are rapidly evolving in the field. 

There are various treatments for PAD. The type of treatment is determined by the extent or severity of the disease. If your peripheral artery disease is detected early, you can make lifestyle changes to help you manage your disease.

Exercising and walking regularly, for instance walking at least 30 minutes, 3 times a week, may help improve your symptoms.

Your physician may also recommend medication to treat conditions that worsen or complicate leg artery disease. These medications may include cholesterol-lowering drugs (statins) or blood pressure-lowering medications. You may also need to take medications that reduce blood clotting to minimize the chances of clots blocking your narrowed arteries.

Your physician may also prescribe cilostazol (Pletal), which can improve the distance you are able to walk without discomfort or pain. Other drugs your physician may prescribe include aspirin and clopidogrel (Plavix), either of which can decrease your chances of developing blood clots.

In some cases of peripheral artery disease, your physician may recommend angioplasty and stenting. This procedure is considered to be minimally invasive in comparison to open surgery. It is most effective for more localized blockages in the larger arteries. In an angioplasty, your physician inserts a long, thin, flexible tube called a catheter into your artery. The catheter is guided through your arteries to the blocked area. Once in place, a special balloon, which is attached to the catheter, is inflated and deflated. The balloon pushes the plaque in your artery against your artery walls, widening the vessel. In some circumstances, your vascular surgeon may then place a tiny mesh-metal tube, called a stent, into the narrowed area of your artery to keep it open. The stent remains permanently in your artery. After this procedure, blood flows more freely through your artery.

Bypass surgery creates a detour around a narrowed, or blocked, section of a leg artery. To create this bypass, your vascular surgeon uses one of your veins or a tube made from man-made materials. Your vascular surgeon attaches the bypass above and below the area that is blocked. This creates a new path for your blood to flow to your leg tissues and is particularly effective for extensive artery blockages.

The first priority in chronic peripheral arterial disease (PAD) is treatment of risk factors; smoking cessation and control of blood pressure and cholesterol top the list. These measures do not necessarily improve the circulation to the legs, but they help to prevent heart attack and stroke, common serious cardiovascular complications that affect people with PAD. Another noninvasive maneuver that may improve symptoms is exercise. A cardiologist will usually perform a stress test, often involving a chemical stressor, before referring the patient to an exercise program to improve the distance he or she can walk before developing symptoms. If lifestyle-limiting symptoms persist with these noninvasive measures, imaging tests such as a magnetic resonance angiogram can define arterial anatomy. In some cases, nonsurgical revascularization approaches such as balloon angioplasty or stenting can relieve obstructions and improve symptoms. In other cases, surgical intervention is the best choice.

Dr. John J. Marshall, MD
Cardiologist (Heart Specialist)

PAD is treated in several different ways, depending on its severity.

The PAD disease process is similar to the narrowing that affects heart arteries – where fatty deposits called plaque build up and eventually obstruct blood flow and raise blood pressure. As a result, the treatments are similar. They aim to promote clear, flexible healthy vessels so blood flow is restored.

The first stage of treatment strategies doctors usually recommend for mild PAD are based on lifestyle changes, and may include medications, too. Among the strategies are:

  • Quit smoking; eliminating tobacco use may be the most important step you can take
  • Take part in an approved exercise program, such as structured walking
  • Eat a healthful, low-fat diet
  • Maintain a healthy weight
  • Take prescribed medications for high blood pressure, thinning the blood to prevent clots, and lowering cholesterol, as determined by your doctor

In more serious cases of PAD, where leg pain is so severe and persistent that walking is problematic, the lifestyle changes and medications may be combined with a minimally invasive procedure performed by a physician who specializes in blood vessel health, or through surgery to create a detour around the vessel blockages to restore blood flow.

Peripheral artery disease (PAD) can narrow the arteries carrying blood to the legs, which then causes pain when you walk. To treat this condition, surgeons can insert small wires or catheters into the arteries and try to reopen those narrow segments with balloon angioplasty, sometimes putting stints in. They also have other minimally invasive devices that can remove the plaque filling at the artery. Newer devices, which are almost like a rotor blade-type device, attempt to clean out the artery and make the lumen (the cavity inside the tube) wider.

Surgeons can also perform bypass operations in the legs for more advanced PAD. The right treatment for PAD can be life changing. People will be able to walk longer distances, and tolerate more in terms of work and exercise. It will also help reduce their risk of developing more advanced complications.

Treatment of peripheral arterial disease (PAD)—where narrowing or blockage of an artery leads to reduced blood flow to a limb—depends on the symptoms. If people have pain in their legs when they walk, doctors first evaluate them by doing non-invasive tests and angiograms of their legs to see if there's a blockage, where it is, how severe it is and whether it's accessible to fixing. Doctors can open blockages with balloons and stents, much like they can with coronary arteries.

The other part of treating PAD is treating the risk of coronary disease; people with PAD need to have their cholesterol and blood pressure checked, as well as very aggressive treatment of cholesterol and blood pressure if needed. They should also be screened for diabetes.

Probably the most important factor in PAD, as in coronary disease, is smoking: there's a direct relationship between smoking and blockage of arteries in the legs (and the entire cardiovascular system).

Peripheral artery disease (PAD) is usually treated with lifestyle modifications to modifying risk factors.

Exercise is one of the most important treatment modalities for people with PAD. Too often people complain of pain when they walk and as a result they walk less or exercise less. People should walk more and exercise more. What that does is help the body develop and grow 'collaterals' or small blood vessels to help feed the muscle with more blood supply.

Other lifestyle modifications for PAD include:

  • eating healthy
  • quitting smoking
  • controlling blood pressure
  • controlling cholesterol

Trinity Health is a Catholic health care organization that acts in accordance with the Catholic tradition and does not condone or support all practices covered in this site. In case of emergency call 911. This site is educational and not a substitute for professional medical advice, always seek the advice of a qualified health care provider.

Treatments for peripheral arterial disease (PAD) include lifestyle changes, medicines and surgery or procedures.

The overall goals of treating PAD are to reduce symptoms, improve quality of life, and prevent complications. Treatment is based on your signs and symptoms, risk factors and results from a physical exam and tests.

Lifestyle Changes
Treatment often includes making long-lasting lifestyle changes, such as:

  • Quitting smoking. Your risk for PAD increases four times if you smoke. Smoking also raises your risk for other diseases, such as coronary artery disease (CAD). Talk to your doctor about programs and products that can help you quit smoking.
  • Lowering blood pressure. This lifestyle change can help you avoid the risk of stroke, heart attack, heart failure and kidney disease.
  • Lowering high blood cholesterol levels. Lowering cholesterol can delay or even reverse the buildup of plaque in the arteries.
  • Lowering blood glucose levels if you have diabetes. A hemoglobin A1C test can show how well you have controlled your blood sugar level over the past 3 months.
  • Getting regular physical activity. Talk with your doctor about taking part in a supervised exercise program. This type of program has been shown to reduce PAD symptoms.

Your doctor may prescribe medicines to:

  • Lower high blood cholesterol levels and high blood pressure
  • Thin the blood to prevent clots from forming due to low blood flow
  • Help ease leg pain that occurs when you walk or climb stairs

Surgery or Procedures

  • Bypass Grafting - Your doctor may recommend bypass grafting surgery if blood flow in your limb is blocked or nearly blocked. For this surgery, your doctor uses a blood vessel from another part of your body or a man-made tube to make a graft. This graft bypasses (goes around) the blocked part of the artery, which allows blood to flow around the blockage. This surgery doesn't cure PAD, but it may increase blood flow to the affected limb.
  • Angioplasty - Your doctor may recommend angioplasty (AN-jee-oh-plas-tee) to restore blood flow through a narrowed or blocked artery.

This answer from the National Heart, Lung and Blood Institute has been reviewed and/or edited by Dr. William D. Knopf.

Dr. Joshua I. Greenberg, MD
Vascular Surgeon

When peripheral artery disease (PAD) symptoms occur with walking, then treatment can involve a daily walking program, smoking cessation and risk factor reduction. When lifestyle limiting symptoms occur, then more invasive strategies ranging from minimally invasive stenting to surgery might be necessary to re-route the blood around the blockages, much like heart bypass surgery, but for the leg.

When the circulation is so critically compromised that pain occurs in the foot at rest, or wounds develop that won't heal, or even gangrene, then something invasive must be done. And time is of the essence in order to prevent amputation. People in this category actually have a 20 percent chance of death in the first year after diagnosis, so this is really about life and limb. A vascular surgeon should be involved who has at his or her disposal all the tools required to save that limb along with a multidisciplinary team including podiatrists (foot doctors).

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Important: This content reflects information from various individuals and organizations and may offer alternative or opposing points of view. It should not be used for medical advice, diagnosis or treatment. As always, you should consult with your healthcare provider about your specific health needs.