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Diagnosis
Some of the tests your doctor may rely on to diagnose peripheral artery disease are:
Physical exam. Your doctor may find signs of PAD during a physical examination, such as a weak or absent pulse below a narrowed area of your artery, whooshing sounds (bruits) over your arteries that can be heard with a stethoscope, evidence of poor wound healing in the area where your blood flow is restricted, and decreased blood pressure in your affected limb.
Ankle-brachial index (ABI). This is a common test used to diagnose PAD. It compares the blood pressure in your ankle with the blood pressure in your arm.
To get a blood pressure reading, your doctor uses a regular blood pressure cuff and a special ultrasound device to evaluate blood pressure and flow.
You may walk on a treadmill and have readings taken before and immediately after exercising to capture the severity of the narrowed arteries during walking.
Ultrasound. Special ultrasound imaging techniques, such as Doppler ultrasound, can help your doctor evaluate blood flow through your blood vessels and identify blocked or narrowed arteries.
Angiography. By injecting a dye (contrast material) into your blood vessels, this test allows your doctor to view blood flow through your arteries as it happens. Your doctor is able to trace the flow of the contrast material using imaging techniques, such as X-ray imaging or procedures called magnetic resonance angiography (MRA) or computerized tomography angiography (CTA).
Catheter angiography is a more invasive procedure that involves guiding a catheter through an artery in your groin to the affected area and injecting the dye that way. Although invasive, this type of angiography allows for simultaneous diagnosis and treatment — finding the narrowed area of a blood vessel and then widening it with a dilating procedure or administering medication to improve blood flow.
Blood tests. A sample of your blood can be used to measure your cholesterol and triglycerides and to check for diabetes.
Treatment
Treatment for peripheral artery disease has two major goals:
Manage symptoms, such as leg pain, so that you can resume physical activities.
Stop the progression of atherosclerosis throughout your body to reduce your risk of heart attack and stroke.
You may be able to accomplish these goals with lifestyle changes. If you smoke, quitting is the single most important thing you can do to reduce your risk of complications.
If lifestyle changes are not enough, you will need additional medical treatment. Your doctor may prescribe medicine to prevent blood clots, lower blood pressure and cholesterol, and control pain and other symptoms.
Medications
Cholesterol-lowering medications. You may take a cholesterol-lowering drug called a statin to reduce your risk of heart attack and stroke.
The goal for people who have peripheral artery disease is to reduce low-density lipoprotein (LDL) cholesterol, the "bad" cholesterol, to less than 100 milligrams per deciliter (mg/dL), or 2.6 millimoles per liter (mmol/L). The goal is even lower if you have additional major risk factors for heart attack and stroke, especially diabetes or continued smoking.
High blood pressure medications. If you also have high blood pressure, your doctor may prescribe medications to lower it.
The goal of this therapy is to reduce your systolic blood pressure (the top number of the two numbers) to 140 millimeters of mercury (mm Hg) or lower and your diastolic blood pressure (the bottom number) to 90 mm Hg or lower. If you have diabetes, your blood pressure target is under 130/80 mm Hg.
Medication to control blood sugar. If you also have diabetes, it becomes even more important to control your blood sugar (glucose) levels. Talk with your doctor about what your blood sugar goals are and what steps you need to take to achieve these goals.
Medications to prevent blood clots. Because peripheral artery disease is related to reduced blood flow to your limbs, it's important to improve that flow.
Your doctor may prescribe daily aspirin therapy or another medication, such as clopidogrel (Plavix).
Symptom-relief medications. The drug cilostazol (Pletal) increases blood flow to the limbs both by keeping the blood thin and by widening the blood vessels. It specifically helps treat symptoms of claudication, such as leg pain, for people who have peripheral artery disease. Common side effects of this medication include headache and diarrhea.
An alternative to cilostazol is pentoxifylline (Trental); however, it's generally less effective. But side effects are rare with this medication.
Angioplasty and surgery
Angioplasty. In this procedure, a small hollow tube (catheter) is threaded through a blood vessel to the affected artery. There, 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.
Bypass surgery. Your doctor may create a graft bypass using a vessel from another part of your body or a blood vessel made of synthetic fabric. This technique allows blood to flow around — or bypass — the blocked or narrowed artery.
Thrombolytic therapy. If you have a blood clot blocking an artery, your doctor may inject a clot-dissolving drug into your artery at the point of the clot to break it up.
Lifestyle and home remedies
Many people can manage the symptoms of peripheral artery disease and stop the progression of the disease through lifestyle changes, especially quitting smoking. To stabilize or improve PAD:
Stop smoking. Smoking contributes to constriction and damage of your arteries and is a significant risk factor for the development and worsening of PAD. If you smoke, quitting is the most important thing you can do to reduce your risk of complications.
If you're having trouble quitting on your own, ask your doctor about smoking cessation options, including medications to help you quit.
Exercise. This is a key component. Success in treatment of PAD is often measured by how far you can walk without pain. Proper exercise helps condition your muscles to use oxygen more efficiently.
Your doctor can help you develop an appropriate exercise plan. He or she may refer you to a claudication exercise rehabilitation program.
Eat a healthy diet. A heart-healthy diet low in saturated fat can help control your blood pressure and cholesterol levels, which contribute to atherosclerosis.
Avoid certain cold medications. Over-the-counter cold remedies that contain pseudoephedrine (Advil Cold & Sinus, Aleve-D Sinus & Headache, Claritin-D, Sudafed, Tylenol Cold, Zyrtec-D, others) constrict your blood vessels and may increase your PAD symptoms.
Alternative medicine
The blood-thinning effects of ginkgo may allow people with intermittent claudication to walk longer distances with less pain. However, this herbal remedy can cause bleeding when taken in high doses, and it could be dangerous if paired with anti-platelet medications, including aspirin, which are commonly prescribed to people with PAD.
Some of the tests your doctor may rely on to diagnose peripheral artery disease are:
Physical exam. Your doctor may find signs of PAD during a physical examination, such as a weak or absent pulse below a narrowed area of your artery, whooshing sounds (bruits) over your arteries that can be heard with a stethoscope, evidence of poor wound healing in the area where your blood flow is restricted, and decreased blood pressure in your affected limb.
Ankle-brachial index (ABI). This is a common test used to diagnose PAD. It compares the blood pressure in your ankle with the blood pressure in your arm.
To get a blood pressure reading, your doctor uses a regular blood pressure cuff and a special ultrasound device to evaluate blood pressure and flow.
You may walk on a treadmill and have readings taken before and immediately after exercising to capture the severity of the narrowed arteries during walking.
Ultrasound. Special ultrasound imaging techniques, such as Doppler ultrasound, can help your doctor evaluate blood flow through your blood vessels and identify blocked or narrowed arteries.
Angiography. By injecting a dye (contrast material) into your blood vessels, this test allows your doctor to view blood flow through your arteries as it happens. Your doctor is able to trace the flow of the contrast material using imaging techniques, such as X-ray imaging or procedures called magnetic resonance angiography (MRA) or computerized tomography angiography (CTA).
Catheter angiography is a more invasive procedure that involves guiding a catheter through an artery in your groin to the affected area and injecting the dye that way. Although invasive, this type of angiography allows for simultaneous diagnosis and treatment — finding the narrowed area of a blood vessel and then widening it with a dilating procedure or administering medication to improve blood flow.
Blood tests. A sample of your blood can be used to measure your cholesterol and triglycerides and to check for diabetes.
Treatment
Treatment for peripheral artery disease has two major goals:
Manage symptoms, such as leg pain, so that you can resume physical activities.
Stop the progression of atherosclerosis throughout your body to reduce your risk of heart attack and stroke.
You may be able to accomplish these goals with lifestyle changes. If you smoke, quitting is the single most important thing you can do to reduce your risk of complications.
If lifestyle changes are not enough, you will need additional medical treatment. Your doctor may prescribe medicine to prevent blood clots, lower blood pressure and cholesterol, and control pain and other symptoms.
Medications
Cholesterol-lowering medications. You may take a cholesterol-lowering drug called a statin to reduce your risk of heart attack and stroke.
The goal for people who have peripheral artery disease is to reduce low-density lipoprotein (LDL) cholesterol, the "bad" cholesterol, to less than 100 milligrams per deciliter (mg/dL), or 2.6 millimoles per liter (mmol/L). The goal is even lower if you have additional major risk factors for heart attack and stroke, especially diabetes or continued smoking.
High blood pressure medications. If you also have high blood pressure, your doctor may prescribe medications to lower it.
The goal of this therapy is to reduce your systolic blood pressure (the top number of the two numbers) to 140 millimeters of mercury (mm Hg) or lower and your diastolic blood pressure (the bottom number) to 90 mm Hg or lower. If you have diabetes, your blood pressure target is under 130/80 mm Hg.
Medication to control blood sugar. If you also have diabetes, it becomes even more important to control your blood sugar (glucose) levels. Talk with your doctor about what your blood sugar goals are and what steps you need to take to achieve these goals.
Medications to prevent blood clots. Because peripheral artery disease is related to reduced blood flow to your limbs, it's important to improve that flow.
Your doctor may prescribe daily aspirin therapy or another medication, such as clopidogrel (Plavix).
Symptom-relief medications. The drug cilostazol (Pletal) increases blood flow to the limbs both by keeping the blood thin and by widening the blood vessels. It specifically helps treat symptoms of claudication, such as leg pain, for people who have peripheral artery disease. Common side effects of this medication include headache and diarrhea.
An alternative to cilostazol is pentoxifylline (Trental); however, it's generally less effective. But side effects are rare with this medication.
Angioplasty and surgery
Angioplasty. In this procedure, a small hollow tube (catheter) is threaded through a blood vessel to the affected artery. There, 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.
Bypass surgery. Your doctor may create a graft bypass using a vessel from another part of your body or a blood vessel made of synthetic fabric. This technique allows blood to flow around — or bypass — the blocked or narrowed artery.
Thrombolytic therapy. If you have a blood clot blocking an artery, your doctor may inject a clot-dissolving drug into your artery at the point of the clot to break it up.
Lifestyle and home remedies
Many people can manage the symptoms of peripheral artery disease and stop the progression of the disease through lifestyle changes, especially quitting smoking. To stabilize or improve PAD:
Stop smoking. Smoking contributes to constriction and damage of your arteries and is a significant risk factor for the development and worsening of PAD. If you smoke, quitting is the most important thing you can do to reduce your risk of complications.
If you're having trouble quitting on your own, ask your doctor about smoking cessation options, including medications to help you quit.
Exercise. This is a key component. Success in treatment of PAD is often measured by how far you can walk without pain. Proper exercise helps condition your muscles to use oxygen more efficiently.
Your doctor can help you develop an appropriate exercise plan. He or she may refer you to a claudication exercise rehabilitation program.
Eat a healthy diet. A heart-healthy diet low in saturated fat can help control your blood pressure and cholesterol levels, which contribute to atherosclerosis.
Avoid certain cold medications. Over-the-counter cold remedies that contain pseudoephedrine (Advil Cold & Sinus, Aleve-D Sinus & Headache, Claritin-D, Sudafed, Tylenol Cold, Zyrtec-D, others) constrict your blood vessels and may increase your PAD symptoms.
Alternative medicine
The blood-thinning effects of ginkgo may allow people with intermittent claudication to walk longer distances with less pain. However, this herbal remedy can cause bleeding when taken in high doses, and it could be dangerous if paired with anti-platelet medications, including aspirin, which are commonly prescribed to people with PAD.
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