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PAD is a disease that occurs when the blood vessels that supply the limbs with blood, particularly the legs, become narrowed or blocked because of atherosclerosis. PAD management requires the use of medications, lifestyle changes and occasionally surgery.

Medications

• Blood Vessel Dilators: Cilostazol is an anti-anginal drug that enhances the blood circulation in the lower limbs and dilates the blood vessels. It may also assist in decreasing pain in the legs and improving the distance one can walk with intermittent claudication.
• Antiplatelet Agents: Aspirin or clopidogrel is an antiplatelet agent which is useful in preventing blood clots which are also useful in preventing complications of PAD.
• Statins: These medications decrease LDL cholesterol and can also decrease the progression of atherosclerosis and assist in the treatment of PAD.

Foot Care

Foot care is crucial in patients with PAD and particularly diabetic patients to avoid infections and amputations. Here are some key recommendations:

• Regular Foot Inspections: It is recommended that you inspect your feet every day for any sign of injury like cuts, blisters or sores. Skin color and temperature should be monitored because they can reveal circulatory problems.
• Proper Footwear: To reduce the likelihood of getting an injury, one should wear proper fitting and comfortable shoes. Shoes should be protective and supportive so that they do not cause blisters or pressure ulcers on the feet.
• Prompt Wound Care: If you develop any sores or cuts, it is advised to consult a doctor as soon as possible. Cleaning, dressing, and management of wounds are important in order to avoid infections and ensure that the wound heals as required.

When is Surgery Necessary?

Surgery may be necessary for the PAD that is beyond Rutherford category 3, rest pain, ulcer, or gangrene. It is typically considered in the following situations:

• Severe Symptoms: PAD symptoms that limit your ability to function and that do not respond to medications or changes in habits may require surgery.
• Critical Limb Ischemia: In cases with high likelihood of amputation or severe tissue loss, surgery is crucial to restore the blood supply and avoid additional issues.

Surgical Treatment Options

Surgical management of PAD can be classified into two main groups: endovascular procedures and open surgical procedures.

Endovascular Surgery

It is a less invasive procedure that employs thin tubes and instruments to unblock or bypass narrowed arteries with smaller cuts. Endovascular surgery is preferred over open surgery because of its effectiveness and low risk.

Procedure: An operation involves the making of a small cut, which is normally between 5-10mm, in the groin region. A catheter, balloon, and sometimes a stent are passed through the blocked artery. It is done under fluoroscopic control, which means that X-ray is used to visualize the arteries and place the instruments properly.

Benefits:

Less postoperative complications than the open surgery.

Fewer scars and a shorter time to recover.

Beneficial in most types of arterial obstruction.

Open Surgery

Traditional surgical interventions are more invasive and may be necessary when the endovascular techniques are not possible or when the disease is severe.

Bypass Surgery: This involves making a new channel for blood flow around the affected area by using a graft. The graft can be taken from the patient’s own body or it can be an artificial tube. Bypass surgery is applicable to long or complex stenoses.

Endarterectomy: This operation entails the stripping of the plaque from the artery and then closing the artery using a patch. It is often applied in cases of blockages in the larger vessels of the body.

Benefits:

Recommended for serious or long-term blockages.

May help to lessen symptoms and enhance blood flow.

Comprehensive Management of PAD

Effective management of PAD requires a comprehensive approach that includes both medical and lifestyle interventions. Here are some additional strategies to manage PAD effectively:

Lifestyle Modifications

• Quit Smoking: Smoking is a major risk factor for PAD. Quitting smoking can significantly improve vascular health and reduce the progression of the disease.
• Regular Exercise: Engage in supervised exercise programs to improve circulation and reduce symptoms. Walking regimens are particularly beneficial for individuals with PAD.
• Heart-Healthy Diet: Adopt a diet rich in fruits, vegetables, whole grains, and lean proteins. Limiting intake of saturated fats, trans fats, and sodium can help control cholesterol and blood pressure.

Medical Management

• Control Diabetes: Keep blood sugar levels under control through diet, exercise, and medications as prescribed by your doctor.
• Manage Blood Pressure: Maintain blood pressure within a healthy range through lifestyle changes and medications. Aim for blood pressure below 130/85 mmHg.
• Lower Cholesterol: Use diet and medications to reduce LDL cholesterol levels. Target LDL levels below 70 mg/dL.