In this Article

• What is peripheral vascular disease?
• What is atherosclerosis?
• How does atherosclerosis cause disease?
• What are potential complications of peripheral artery disease?
• What are the other causes of peripheral vascular diseases?
• Who is at risk for peripheral artery disease?
• What are the symptoms and signs of peripheral artery disease?
• How is peripheral artery disease diagnosed?
• What are the treatments for peripheral artery disease?
• Lifestyle changes
• Supervised exercise
• Medications
• Angioplasty
• Surgery
• Peripheral Vascular Disease At A Glance
• Patient Discussions: Peripheral Vascular Disease - Describe Your Experience
• Peripheral Vascular Disease Glossary
• Peripheral Vascular Disease Index

Medications

While lifestyle changes may be enough treatment for some people with peripheral artery disease, others may require medication. Examples of medications used in treating peripheral artery disease include anti-platelet or anti-clotting agents, cholesterol-lowering drugs such as statins, medications that increase blood supply to the extremities such as cilostazol (Petal) and pentoxifylline (Trental), and medications that control high blood pressure.

• Antiplatelet medications [such as aspirin and clopidogrel (Plavix)] make the blood platelets less likely to stick to one another to form blood clots. Low dose aspirin (81-325 mg/day) is usually prescribed indefinitely because it is also helpful in preventing strokes and heart attacks in patients with peripheral artery disease. Clopidogrel (Plavix) is an alternative to aspirin for those who are allergic or cannot tolerate aspirin. Anti-platelet medications also help prevent occlusion of blood vessels after angioplasty or bypass surgery.

• Anticoagulant medications act to prevent blood clotting. Both heparin and warfarin (Coumadin) are anticoagulant medications. Anticoagulants are sometimes prescribed for people with peripheral artery disease if they are at increased risk for formation of blood clots; these agents are used much less frequently than anti platelet agents in patients with PAD.

• Cholesterol-lowering drugs of the statin family have been shown in numerous large clinical trials to help prevent heart attacks and strokes and prolong survival among patients with atherosclerosis. Statins have also been shown to slow the progression of peripheral artery disease, decrease arthrosclerosis in the arteries, and improve claudication symptoms. Current NCEP recommendations for patients with peripheral artery disease are to use diet and medications (such as statins) to lower LDL cholesterol to below 100 mg/dl. Many doctors are now recommending lowering LDL cholesterol even further for patients with peripheral artery disease to below 75-80 mg/dl.

• Cilostazol (Pletal) is a mediation that can help increase physical activity (enabling one to walk a greater distance without the pain of claudication). Cilostazol works by causing dilation of the arteries and an increased supply of oxygenated blood to be delivered to the arms and legs. Cilostazol is recommended for some patients with claudication when lifestyle modifications and exercise are ineffective. Cilostazol should be taken on an empty stomach either a half an hour before or two hours after meals. High fat meals, grapefruit juice, and certain medications such as omeprazole (Prilosec) and diltiazem (Cardizem) can increase the absorption and hence the blood levels of Cilostazol. Side effects are generally mild that include headache, diarrhea and dizziness. Cilostazol should not be used in patients with heart failure because of concern over increased mortality in heart failure patients using medications similar to Cilostazol.

• Pentoxifylline (Pentoxyl, Trental) was designed and approved to improve blood flow to the extremities by decreasing the viscosity ("stickiness") of blood, enabling more efficient blood flow. Pentoxifylline, in clinical trials, improved walking distance, but its benefits are weaker than those of Cilostazol and have not been conclusively proved by all studies.

• Drugs to control hypertension may also be prescribed. There was concern that beta blockers used to treat hypertension can aggravate claudication. But recent studies have not found any adverse effects of beta-blockers on symptoms of patients with peripheral artery disease. Therefore current recommendations are to treat hypertension in patients with peripheral artery disease to prevent strokes and heart attacks.

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