Peripheral Vascular Disease Management

What Is Peripheral Vascular Disease Management

Peripheral artery disease is a narrowing of the arteries that carry blood to the legs, caused by plaque buildup. The typical symptom is pain, aching, or cramping in the calf when walking that goes away after resting, called claudication, but many people with the disease have no symptoms. The same plaque is usually also present in the blood vessels of the heart and brain, so people with this disease are at high risk of heart attack and stroke. Managing this disease protects the legs as well as the heart and brain.

How It Works at a Glance

When the leg arteries narrow, the calf muscles do not get enough blood flow when they work harder, for example when walking. Regular walking exercise trains the muscles to use oxygen more efficiently and helps alternative blood flow routes form around the narrowing. Medicines prevent plaque from growing and blood clots from forming. If the narrowing is very severe, the artery can be widened or a new route can be created.

Treatment Steps

• Quitting smoking: the main step, because smoking speeds up narrowing and increases the risk of amputation.
• Medicines: antiplatelets such as aspirin or clopidogrel, a statin with an LDL cholesterol target below 55 mg/dL, and control of blood pressure and blood sugar. In some patients, the doctor may add low-dose rivaroxaban. This is covered on the Integrated Medication Therapy page.
• Structured walking exercise: walk until the pain is moderate, rest, then walk again, for 30 to 60 minutes, 3 or more times a week for at least 12 weeks, ideally with supervision.
• Foot care: check your feet every day, wear well-fitting footwear, and have any wound checked promptly, especially if you have diabetes.
• Widening the artery or bypass: when symptoms remain bothersome despite medicines and exercise, or when there is pain at rest or a wound that does not heal. This is covered on the Peripheral Angioplasty and Peripheral Bypass Surgery pages.

Tests to Assess Severity

Diagnosis and monitoring use the ABI test, which compares the blood pressure at the ankle and the arm, plus duplex ultrasound to see where the narrowing is. CT angiography or angiography is done when widening the artery or bypass is being considered. This is covered on the Ankle-Brachial Index (ABI) Test and Duplex Ultrasound pages.

When the Condition Threatens the Leg

Leg pain at rest, especially at night, wounds on the foot or toes that have not healed for more than two weeks, and blackened skin indicate critical limb ischemia. This condition needs prompt treatment to save the leg. A foot that suddenly turns cold, pale, very painful, or numb is an emergency.

There is no recovery period for a consultation visit. Management continues over the long term alongside your daily activities.

Keep walking even with mild pain. Calf pain during walking exercise does not damage the muscles. Rest until the pain goes away, then continue walking.

Care for your feet every day. Check between your toes and the soles of your feet, keep the skin moisturized, trim your nails carefully, and do not walk barefoot.

Take your medicines regularly. Do not stop blood thinners or statins without your doctor's guidance.

Warning signs. Go to the emergency room right away if you have:

• A foot that suddenly turns cold, pale, very painful, or numb
• Toes or skin on the foot turning black
• A foot wound that is red, swollen, or oozing pus, with fever
• Chest pain, shortness of breath, or facial drooping and arm weakness