This can be divided into medical and surgical treatment.
All patients with PAD will need to be on lifelong medical treatment including antiplatelet agents such as aspirin or plavix to prevent blood clots from forming and narrowing the diseased arteries in the legs further. These medicines also lower the risk of a heart attack and stroke. Newer low dose anti-thrombotics such as Xaraltoi or rivaroxaban are now being increasingly used to help optimise the clogged arteries and prevent new clots from forming in patients with severe PAD. Patients also need to be on lipid lowering management for their cholesterol. This is not to treat just a high cholesterol level on a blood test but also these medicines act on the arteries in a beneficial way. Good blood pressure control along with aggressive diabetes management are essential to prevent PAD progression and treatment outcome.
There are 2 main types of revascularization treatment for PAD – ie to improve blood flow to the legs and feet. One is lower limb angioplasty where a blocked or narrowed section of an artery in the leg is widened by inflating a balloon inside the blood vessel. If this fails a stent or a mechanical scaffold is used to cage the blood vessel open. These are keyhole techniques with minimal downtime to the patient. If the arteries are severely blocked an open bypass operation using vein or artery from the arm may be used to circumnavigate the blocked artery in the leg. If there is no suitable vein or artery available an artificial graft may be used.
Non medical or surgical ways to try and improve blood supply to the feet and legs include walking usually within a supervised exercise training program, quitting smoking and eating more healthily and reducing weight by forced dieting.
