The goals of treatment for peripheral vascular disease (PVD) are to manage symptoms, such as leg pain, and to stop the progression throughout the body, in order to reduce the risk of heart attack and stroke.
Some individuals may be able to treat PVD appropriately with lifestyles changes. Lifestyle changes include quitting smoking, losing weight, exercising, and changing the diet (see "Prevention"). Smoking cessation is the single most important thing an individual can do to reduce the progression of the blockage and to reduce the risk of complications of PVD.
If lifestyle changes are not enough, additional medical treatment may be needed. A doctor may prescribe medicine to prevent blood clots, lower blood pressure
and cholesterol, and control pain and other symptoms.
Experts recommend eating healthy foods. A brain-healthy diet should include five or more daily servings of fruits and vegetables, foods rich in soluble fiber (such as oatmeal and beans), foods rich in calcium (dairy products, spinach), soy products (such as tempeh, miso, tofu, and soy milk), and foods rich in omega-3 fatty acids, including cold-water fish, such as salmon, mackerel, and tuna. Pregnant women and women who plan to become pregnant in the next several years should limit their weekly intake of cold-water fish because of the potential for mercury contamination.
Eating less cholesterol and fat, especially saturated fat, may reduce the amount of plaque in the arteries. Weight loss of as little as 10 pounds may lower blood pressure and improve cholesterol levels.
People with PVD are encouraged to quit smoking because it may worsen symptoms. Quitting smoking will slow the progress of PVD.
People with diabetes should stay in close contact with their doctors to ensure that their condition is well controlled. Managing diabetes with diet, exercise, weight control, and medication is essential because strict control of blood sugar may reduce damage to the heart and blood vessels.
Exercise can lower blood pressure, increase the level of HDL cholesterol (good cholesterol), and improve the overall health of blood vessels and the heart. It also helps control weight, control diabetes, and reduce stress. Thirty minutes daily of exercise is normally recommended. Patients should talk to their doctors before starting a new exercise program.
Managing stress can be vital to keeping the heart and blood vessels healthy. This is because stress can cause an increase in blood pressure along with increasing the blood's tendency to clot.
Medications for claudication: Medications used to treat PVD and intermittent claudication include those that aim to lower the risk and progression of atherosclerosis throughout the body, such as those that help quit smoking, lower blood pressure, lower cholesterol, and optimize the blood sugar in people with diabetes.
Two prescription medications have been approved by the U.S. Food and Drug Administration (FDA) for the direct treatment of the symptom of intermittent claudication. Pentoxifylline (Trental®) is believed to improve blood flow by decreasing the viscosity (thickness) of blood and making red blood cells more flexible. With these alterations, the blood can move more easily past obstructions in the blood vessel. Cilostazol (Pletal®) keeps platelets from clumping together. This clumping promotes formation of clots and slows down blood flow. The drug also helps dilate, or expand, the blood vessels, encouraging the flow of blood.
Other prescription medications used to treat symptoms of PVD include antiplatelet agents, anticoagulants, and "clot-busters" (thrombolytics). Antiplatelet agents include aspirin, ticlopidine (Ticlid®), and clopidogrel (Plavix®). These drugs do not get rid of an existing clot, but they prevent further clots from forming by keeping blood cells and platelets from clumping together. Anticoagulant agents include heparin, warfarin (Coumadin®), enoxaparin (Lovenox®), and low-molecular-weight heparin. These drugs also do not remove an existing clot, but they interfere with the sequence of blood clotting factors that causes a clot to form. Thrombolytics are drugs that can actually dissolve an existing clot. Thrombolytics can be used only under certain circumstances and are given only in the hospital. Thrombolytics can be injected directly into the blocked artery under angiographic guidance. To be effective, they have to be administered intravenously within the first four to eight hours after an individual develops symptoms. All of these medications may increase the chances of bleeding. Individuals should inform their healthcare providers about over-the-counter (OTC) medicines and integrative therapies (such as herbs and vitamins) they may be taking.
Cholesterol-lowering medications: Cholesterol-lowering drugs called statins, such as lovastatin (Mevacor®) or atorvastatin (Lipitor®), may be prescribed by a doctor to reduce the risk for heart attack and stroke. The goal for individuals who have PVD is to reduce low-density lipoprotein (LDL) cholesterol, the "bad" cholesterol, to less than 100 milligrams per deciliter (mg/dL). The goal is even lower if there are additional major risk factors for heart attack and stroke, especially diabetes, or continued smoking. Statin drugs may deplete Coenzyme Q10 from the body, leading to muscle weakness and pain. Coenzyme Q10 is important in cellular energy production.
Blood pressure-lowering medications: If high blood pressure exists, a doctor may prescribe medications to lower it, such as beta-blockers or ACE inhibitors. The goal of these medications is to reduce the systolic blood pressure (the top number of the two numbers) to 140 millimeters of mercury (mmHg) and the diastolic blood pressure (the bottom number) to 90 mmHg or lower. If diabetes is present, the blood pressure goals are even lower.
Medications to control blood sugar: If the individual also has diabetes, blood sugar (glucose) control is even more important. Taking prescribed medications, such as metformin (Glucophage®), appropriately and following a proper diet is necessary.
Medications to prevent blood clots: Because peripheral arterial disease is related to reduced blood flow to the limbs, it is important to reduce the risk of blood clots. A blood clot can completely block an already narrowed blood vessel and cause tissue death. A doctor may prescribe daily aspirin therapy or another medication that helps prevent blood clots, such as clopidogrel (Plavix®) or warfarin (Coumadin®).
Balloon angioplasty: In a balloon angioplasty, a small hollow tube (called a catheter) is threaded through a blood vessel to the affected artery. Then, a small balloon on the tip of the catheter is inflated to reopen the artery and flatten the blockage into the artery wall, while at the same time stretching the artery open to increase blood flow. In some cases, a mesh framework called a stent is deployed and left in the artery to help keep it open. This is the same procedure doctors use to open heart arteries. Stents can also contain drugs that decrease blood clotting. Risks of angioplasty include: bleeding in area where the catheter was inserted, blockage of blood flow to an area of the heart (very rare), damage to a heart valve or blood vessel, kidney failure (higher risk in those with existing kidney problems), irregular heartbeats (arrhythmias), stroke (rare), and death.
Bypass surgery: Bypass surgery can be done on arteries to improve circulation. Bypass surgery involves using one of the individual's own veins or a synthetic graft to re-route blood around a segment of a narrow or blocked artery. Blood flow then goes from the artery, through the bypassed graft, and out to the rest of the body.
Strong scientific evidence
Ginkgo: Ginkgo (Ginkgo biloba) has been used medicinally for thousands of years. Today, it is one of the top-selling herbs in the United States. Numerous studies suggest that Ginkgo biloba taken by mouth causes small improvements in claudication symptoms (leg pain with exercise or at rest due to clogged arteries). However, ginkgo may not be as helpful for this condition as exercise therapy or prescription drugs. Additional evidence is needed. Ginkgo may increase bleeding in sensitive individuals, including those taking blood-thinning medications such warfarin (Coumadin®) and aspirin.
Good scientific evidence
Aortic acid: Aortic acid comes from the hearts of animals, usually sheep, cows, or pigs. Aortic acid is a broad term encompassing several constituents. Mesoglycan, a preparation of glycosaminoglycans, is the most studied of these constituents. Intermittent claudication is part of late stage atherosclerosis, and mesoglycan has shown some therapeutic ability in preliminary atherosclerosis studies in humans. In addition, mesoglycan is a heparin-like substance that has shown anticoagulation ("blood thinning") properties in clinical studies. Additional study is needed.
There are currently no reported allergic reactions available. Due to the heparan sulfate content of mesoglycan, patients with an allergy to heparin or heparinoid derivatives should use caution.
L-carnitine: L-carnitine, or acetyl-L-carnitine, is an amino acid found in the body. There is strong evidence to support l-carnitine's use at least in those cases when there are severe limitations in peripheral circulation. It is not clear, however, whether angiopathies caused by atherosclerosis and diabetes are equally sensitive to the drugs. Additionally, it is important to know comparative efficiency of propionyl-L-carnitine and other recognized treatments.
Policosanol: Policosanol is a cholesterol-lowering natural mixture of primary alcohols, isolated and purified from sugar cane wax. Policosanol is safe and well tolerated. There is limited study on the effects of policosanol supplementation on walking distance in individuals with intermittent claudication. Additional human trials are necessary before a strong recommendation can be made. Avoid in individuals with a known allergy or hypersensitivity to policosanol.
Unclear or conflicting scientific evidence
L-arginine: L-arginine, or arginine, is considered a semi-essential amino acid, because although it is normally synthesized in sufficient amounts by the body, supplementation is sometimes required. Intermittent claudication is a condition characterized by leg pain and fatigue due to buildup of cholesterol plaques or clots in leg arteries. A small number of studies report that arginine therapy may improve walking distance in patients with claudication. Further research is needed.
Garlic: Garlic (Allium sativum) is traditionally used for heart health. Some human studies suggest that garlic may improve circulation in the legs by a small amount, but this issue remains unclear. Better-designed studies are needed. Garlic may increase bleeding in sensitive individuals, including those taking blood-thinning medications such as warfarin (Coumadin®) and aspirin.
People with a known allergy to garlic, any of its ingredients, or to other members of the Liliaceae (lily) family, including hyacinth, tulip, onion, leek, and chives, should avoid garlic. Allergic reactions have been reported with garlic taken by mouth, inhaled, or applied to the skin.
Hydrotherapy: Hydrotherapy is broadly defined as the external application of water in any form or temperature (hot, cold, steam, liquid, ice) for healing purposes. It may include immersion in a bath or body of water (such as the ocean or a pool), use of water jets, douches, application of wet towels to the skin, or water birth. Hydrotherapy may help increase blood flow, temporarily relieving symptoms of PVD.
Vitamin E: Vitamin E is a fat-soluble vitamin with antioxidant properties. Multiple studies have evaluated the use of vitamin E in patients with peripheral vascular disease to improve exercise tolerance and intermittent claudication (pain in the legs with walking due to cholesterol buildup in blood vessels). Although some results have been promising, most studies have been small and poorly designed. It remains unclear if vitamin E is beneficial in this condition. Vitamin E may increase bleeding in sensitive individuals, including those taking blood-thinning medications such warfarin (Coumadin®) and aspirin.
Fair negative scientific evidence
Chelation therapy: Individuals with clogged arteries in the legs (peripheral vascular disease) may experience a sensation of pain or fatigue in the legs with exercise ("claudication"). Chelation is sometimes suggested as a treatment in this situation, but studies suggest that chelation may not be helpful. Chelation therapy is the administration of chelating agents, such as EDTA, to remove heavy metals from the body.
Traditional or theoretical uses lacking sufficient evidence
Integrative therapies with historical or theoretical uses in peripheral vascular disease but lack sufficient clinical evidence include: aconite (Aconitum napellus), bromelain, hawthorn (Crataegusoxyacantha), meditation, niacin (Vitamin B3, Nicotinic acid), niacinamide, octacosanol, omega-3 fatty acids, qi gong, rosemary (Rosmarinus officinalis), and tai chi.
High blood pressure (hypertension) control: One of the most important things that can be done for the prevention of peripheral vascular disease (PVD) is to reduce high blood pressure. Blood pressure for a healthy individual should be a systolic reading of 120 and a diastolic reading of 80 (120/80 millimeters of mercury or mmg Hg). Exercising, managing stress, maintaining a healthy weight, and limiting sodium and alcohol intake are all ways to keep blood pressure in check. Medications to treat hypertension, such as diuretics, angiotensin-converting enzyme (ACE) inhibitors, and angiotensin receptor blockers, may be used.
Cholesterol and saturated fat intake reduction: Eating less cholesterol and fat, especially saturated fat, may reduce the amount of plaque arteries. Most people should aim for a low density lipoprotein (LDL) level below 130 milligrams per deciliter. If there are other risk factors for PVD, such as diabetes, the target LDL may be below 100 milligrams per deciliter. Statin drugs (HMG-CoA reductase inhibitors) can be prescribed to help maintain healthy cholesterol levels.
Smoking cessation: Smoking is a major risk factor for PVD. Nicotine constricts blood vessels and forces the heart to pump harder. A buildup of carbon monoxide (CO) reduces oxygen in the blood and damages the lining of the blood vessels.
Diabetes control: Managing diabetes with diet, exercise, weight control, and medication is essential. Strict control of blood sugar may reduce damage to the heart and blood vessels.
Weight control: Being overweight contributes to other risk factors for stroke, such as high blood pressure, PVD, cardiovascular disease, and diabetes. Weight loss of as little as 10 pounds may lower blood pressure and improve cholesterol levels.
Exercise: Exercise can lower blood pressure, increase the level of HDL cholesterol (good cholesterol), and improve the overall health of blood vessels and heart. It also helps control weight, control diabetes, and reduce stress. Thirty minutes of daily of exercise is normally recommended. Patients should talk to their doctors before starting a new exercise program.
Stress management: Stress can cause an increase in blood pressure along with increasing the blood's tendency to clot. Managing stress can be vital to keeping the heart and blood vessels healthy.
Diet modification: Experts recommend eating healthy foods. A healthy diet should include five or more daily servings of fruits and vegetables, foods rich in soluble fiber (such as oatmeal and beans), foods rich in calcium (dairy products, spinach), soy products (such as tempeh, miso, tofu, and soy milk), and foods rich in omega-3 fatty acids, including cold-water fish, such as salmon, mackerel, and tuna. Pregnant women and women who plan to become pregnant in the next several years should limit their weekly intake of cold-water fish because of the potential for mercury contamination.