What Are the Newest Treatment Options for PAD?

This article is for people who have peripheral artery disease (PAD), or anyone who wants to learn more about it. The goal of this patient education activity is to increase knowledge about treatment options for PAD, including blood thinners.

You will learn about:

• Problems you can have with PAD

• How PAD is treated

• The role of blood thinners in PAD

• When to get emergency care

• Questions to ask your doctor

PAD affects more than just the legs. PAD can get worse over time, making it more difficult and painful for you to walk.

A blood clot can develop over plaque (fatty deposits) in the arteries, blocking blood flow to parts of the body, like the legs (limbs). People with PAD are also at a higher risk of getting a blood clot in the heart (heart attack) or brain (stroke) than people who do not have PAD.

When you have PAD, it is important to take good care of yourself. The following steps can help improve leg symptoms:

• Stop smoking: Smoking is a big cause of PAD so, if you smoke, it is important to stop

• Take care of your feet: Wash, dry, and moisturize your feet every day. Wear comfortable shoes with socks

• Exercise at least 30 minutes most days of the week: If you’re not able to walk outside or on a treadmill, other aerobic exercises like leg stepping or cycling can help. Supervised exercise therapy may also be available

The following steps can help keep your heart healthy:

• Have a heart-healthy diet: Eat more fruits, vegetables, and grains

• Maintain a healthy weight: Have smaller portions to control calorie intake, eat healthy snacks if you get hungry in between meals, and stay physically active

• Manage other health conditions: Keep taking medicines as directed for high blood pressure, high cholesterol (eg, a statin), and diabetes, if you have any of those conditions

There are nonsurgical and surgical procedures that can help improve blood flow to the limbs.

Standard procedures that are typically done for people with PAD include:

• Balloon angioplasty: A small balloon is inflated inside the blocked artery to open it up

• Stent placement: A thin mesh tube or "stent" can be placed to permanently keep the artery open. This is done at the same time as angioplasty

• Bypass surgery: This major surgery connects blood vessels taken from another part of the body to blood vessels around the blocked artery in your limb

Sometimes, a blood clot can form and increase the risk of losing a limb. In this kind of emergency situation, your doctor might recommend one of these procedures to help save a limb:

• Thrombolytic or “clot busting” medicine: Medicine is given through a catheter in the hospital to dissolve a blood clot

• Thrombectomy: This less invasive procedure removes a blood clot that is blocking blood flow and oxygen to the legs. During this procedure, a device is inserted into a blood vessel to remove the clot

• Angioplasty and/or stenting: A small balloon is inflated to open a blocked artery and a thin mesh tube or "stent" can be placed to permanently keep the artery open

• Limb amputation: In this surgery, the damaged part of a limb is removed permanently. This is the last treatment option for PAD when other measures (eg, taking medicines, procedures) do not work

Even if you are doing your best to have a healthy lifestyle or had a procedure, you will need to take medicine for your PAD, like a cholesterol-lowering medicine (eg, statin) and one or more blood thinners. A blood thinner can help prevent blood clots in the limbs and lower your chances of having a heart attack or stroke.

There are 2 major types of blood thinners: antiplatelet and anticoagulants. Antiplatelet medicines, like aspirin and clopidogrel, have been used to treat people with heart disease for a long time. They can help people with PAD, too, by stopping blood clots from forming and preventing a heart attack or stroke.

The other type of blood thinner is an anticoagulant. This medicine can slow down the body's process of making blood clots and stop a clot forming in an artery.

Anticoagulants have been used to treat blood clots in the legs and lungs. An anticoagulant called rivaroxaban (taken with aspirin) may help prevent a heart attack or stroke in people with PAD who have a low risk of bleeding.

People with a higher risk of getting a blood clot and a lower risk of bleeding may be placed on an anticoagulant, in addition to other medicines for PAD.

Nuisance bleeding can happen if you’re taking a blood thinner.

Serious side effects can also happen, but they are not very common. You should call your doctor if you have:

• Unusual bruising

• Bleeding for a long time from cuts, the gums, or shaving

• Nosebleeds that are uncommon or don't stop

• Coughing up blood

• Blood in vomit or urine

• Unusual pain/swelling/discomfort

• Severe headache, dizziness/fainting, feeling tired

• Trouble swallowing

Get medical attention immediately if you have any of the following symptoms:

• Sudden pain in the calf, thigh, buttocks, or hip

• Sudden change in skin color or temperature (for example, pale, blue, or cold skin)

• Prickling like "pins and needles" or burning that does not resolve with rest

• You can't move your leg (paralyzed)

• Pain or cramping in your leg with your skin that feels warm, looks red, and is swollen

Call 911 right away if you think you are having a heart attack or stroke:

Symptoms of a Heart Attack
Chest pain or pressure that may travel to your arms, neck, jaw, or back and is not relieved with rest Pressure or pain in the upper abdomen (stomach) Shortness of breath Nausea Sweating Feeling lightheaded or fainting

Symptoms of a Stroke
Face droops or feels numb Arm feels weak or numb; trouble lifting arms Speech is slurred or jumbled; trouble understanding Leg feels weak or numb; trouble walking Trouble seeing in 1 or both eyes Confusion, headache, dizziness, loss of balance or coordination

Questions you can ask your doctor about lowering your risk for limb and heart problems can include:

• What is my risk for having a heart attack or stroke?

• What treatments are available, and what are their side effects?

• What can I do to stay healthy?

• When should I get emergency help?

You have successfully completed the program What Are the Newest Treatment Options for PAD?

View Additional Materials on this topic that you may find useful

Society of Vascular Medicine (SVM) Vascular Medicine Journal -- Exercise and PAD

Society of Vascular Medicine (SVM) Vascular Medicine Journal-- What Is PAD?

American Heart Association (AHA) -- PAD Interactive Library

American Heart Association (AHA) -- Take Your Socks Off