Treatment of Peripheral Artery Disease

Lifestyle measures and medical treatments

If you are diagnosed with intermittent claudication it is imperative that if you still smoke then you take measures to stop as soon as you can. There are many sources of support available, and your GP can help you. Treating some of your other cardiovascular risk factors with medication, such as blood pressure, cholesterol and diabetes will help. A structured exercise program can help to improve the distance you can walk, and at the very least prevent things from worsening. Most people will be able to improve the distance they are able to walk with these measures alone.

Angioplasty

If your symptoms are limiting your lifestyle significantly, and if the pattern of disease is suitable, an angioplasty may be attempted. This involves at least a day admission to hospital, and on the day of admission you should have a light breakfast only at 6am. The procedure is performed under local anaesthetic, and you will have to lie flat in a specially designed imaging suite for a period of time. Usually a puncture is made in the groin, but sometimes it can be behind the knee. A balloon is blown up in the narrowing, and on occasions a stent may be placed to keep it open. After the procedure you will be asked to lay flat in bed for 4-6 hours, and if all is well you may be able to go home. Occasionally the puncture can bleed and a bruise will develop. Even more rarely this requires a minor operation to fix. There is a risk of the blockage being made worse (1%) necessitating urgent surgery.After discharge you can resume normal activity and will be seen in the clinic later to check on your progress.

Bypass surgery

If your symptoms persist, or if the type of disease is not suitable for an angioplasty, then bypass surgery may be an option. Bypass surgery is also used to treat popliteal aneurysms in the lower limb. You will have a general anaesthetic and incisions will be made above and below the blocked length arteries. If possible a length of vein will be harvested from the same leg, turned around to allow flow past the valves, and joined to the arteries with fine stitches. If there is no vein suitable then a synthetic graft can be used in place, but natural conduits such as vein are less likely to block off later. The incisions will be closed with absorbable stitches and you will be woken up in the recovery area before returning to the ward. On occasions it may be necessary to spend a short time in the high-dependency unit.


Rehabilitation