Peripheral Arterial Disease (PAD)- Claudication, Rest pain & Critical ischemia
Treatments for Peripheral Arterial Disease (PAD)
Treatments for PAD include
- Lifestyle changes as detailed previously
- Angioplasty+/- stenting
- Bypass surgery
The benefits of walking and exercise
Research shows that sustained exercise over a period of time can improve your circulation and decrease the pain you suffer when walking. Walking and exercise thus
- Reduces the risk of needing an operation
- Reduces pain
- Increases blood flow to the legs
Exercise also benefits your general health
- It can help to reduce your blood pressure and cholesterol
- It helps you to keep at a healthy weight or to loose weight
- It improves your mood
You should walk 5 to 7 days every week
For how long?
The ling term goal is to walk for a continuous 30 minutes. Most people start with 5 to 10 minutes at a time gradually increasing to 30 minutes each walk. This build up takes about 12 weeks. You may take short breaks during the walk but try and complete your allocated time.
How hard should I walk?
Ideally, to really feel the benefits of walking you need to walk 'through' the pain in your muscles to a point where the pain is quite intense. Look at the table given below- you should aim to walk to level 3 of the scale.
Claudication pain scale
Definite discomfort or pain but only at an initial or modest level
Moderate discomfort or pain from which you can be distracted
Intense pain from which you cannot be distracted
Unbearable pain-you should not continue to walk if you are experiencing this level of pain. Stop, rest and resume when you are able.
When you reach level 3- STOP and REST. Allow the pain to completely subside before continuing again. The rest time is not counted as part of your overall walking time.
But don't over do it
Whilst you walk it is normal to feel:
- Warm and a little sweaty
- Slightly short of breath but able to carry out a normal conversation
- Your heart beating a bit faster than usual BUT not racing
If you feel any of the following symptoms-SLOW DOWN OR STOP
- Very short of breath
- A pounding or racing heart
- Extreme fatigue
- Chest pain
- Blurred vision
If you do get these symptoms consult your doctor before doing any further exercise.
- Cool down- if you have been walking quite fast it is important to cool down. You can do this in the house by gently walking around for a few minutes or by sitting in a chair gently tapping your toes or circling your ankles.
- Keep a record of your walk in your diary
When shouldn't I walk?
If you experience any of the following take a rest day and do not return to your walking programme until you feel better.
- A bad cold, flu, high temperature, very tired or generally unwell
- An injury to muscles or joints
- Acute episode of arthritic pain in ankles, knees or hips
- New or increased episodes of chest pain, dizziness, palpitations or breathlessness.
Medications commonly prescribed for PAD are:
- Anti-platelet drugs like Aspirin or Clopidogrel
- A statin
- Blood pressure medication if needed
- A selective inhibitor of Phosphodiesterase-111 may be prescribed to improve walking.
Please consult your doctor or a vascular surgeon before commencing any of the above medication.
On occasions, if indicated, your vascular surgeon may recommend stretching up of your narrowed artery with a balloon. This is called an angioplasty. This is similar to angioplasty carried out for coronary arteries. On occasions a stent may be inserted after the angioplasty, to keep the blood vessel open
These procedures should only be carried out only on the recommendation of your vascular surgeon, after a full assessment has been made. Although generally a safe procedure it can have unwanted consequences and this may need urgent surgical correction. These procedures are thus generally only recommended for critical ischemia.
Surgical bypass is usually reserved for critical ischemia i.e.; if there is a chance of the limb being lost if a bypass is not done.
Surgical bypasses for Critical limb ischemia are complex procedures and are major surgical undertakings. Your vascular surgeon will not normally recommend a bypass for intermittent claudication. He may recommend it, if there are symptoms of rest pain or tissue loss (ulcers & gangrene).
Some common surgical bypass procedures.
Bypasses are also done to the blood vessels lower down the leg, especially in diabetics. Sometimes, amputation of toes may be necessary to salvage the limb.
If the leg is not salvageable (i.e.: it is dead) it may pose a risk to life and it may have to be amputated as a life saving procedure.
Remember, Peripheral Arterial Disease is a warning sign of generalised arterial disease and patients with PAD are more susceptible to heart attacks and stroke. Lifestyle modification, cessation of smoking, weight loss and control of diabetes and hypertension along with graduated exercise forms the cornerstone of treatment.
Occasionally angioplasty or surgical bypass may be necessary. In a minority of cases amputation may need to be done as a life saving procedure.