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Peripheral arterial disease: diagnosis and management

Some treatments may not be suitable for you, depending on your exact circumstances. If you have questions about specific treatments and options covered in this information, please talk to a member of your healthcare team.

Most people with intermittent claudication can manage their pain with exercise and treatments that reduce the risk of other cardiovascular problems.

People with intermittent claudication should be offered a group-based supervised exercise programme. The programme aims to help people build up their strength gradually, and typically should involve 2 hours of supervised exercise a week for 3 months. In these sessions you should be encouraged to exercise until you feel pain in your legs, rest, then exercise again.

If the supervised exercise programme does not help to relieve your symptoms sufficiently, another option is 'revascularisation' (procedures on the arteries that increase the amount of blood that can get to your legs). See the box below for information about revascularisation procedures and imaging tests.

Information about revascularisation

Revascularisation is a term for any procedure that is used to restore the blood flow to an area of the body that is supplied by narrowed or blocked arteries.

This can be done either by making the narrowed arteries wider (angioplasty), or by using another blood vessel to bypass the blocked or narrowed artery (bypass surgery).

Angioplasty is a procedure in which a small balloon is inserted into the narrowed artery and inflated to widen the artery. An expandable mesh tube (called a stent) may be needed in the widened section of artery to keep it open.

In bypass surgery, the blood flow is redirected from the section of artery above the blocked or narrowed area to rejoin the artery below the blocked section. This is done using a vein taken from somewhere else in the body or a synthetic tube and 'grafting' it into place above and below the blockage. NICE says that bypass surgery for treating peripheral arterial disease should use a vein from elsewhere in the body whenever

possible.

Depending on the location of the artery that needs to be widened, revascularisation can be done as 'keyhole' surgery or 'open surgery'. Keyhole surgery is less invasive and is done either while you are awake (using sedation and a local anaesthetic) or under a general anaesthetic. Open surgery is more invasive, and may involve a general anaesthetic and a longer recovery time. Your healthcare team will be able to give you more information.

If you have peripheral arterial disease and your healthcare professional thinks that revascularisation could be a possible treatment for you, they should offer you imaging tests to see whether it would be suitable. The first of the tests should be an ultrasound scan. If further imaging is needed, you should be offered a magnetic resonance (MR) scan. If an MR scan is not suitable for you (for example, if you have a pacemaker), you should be offered a different type of scan called computed tomography (CT).

If changes to your lifestyle and the supervised exercise programme have not improved your intermittent claudication symptoms sufficiently, you should be offered angioplasty (with or without a stent) if it is suitable for you. This will depend on the results of the imaging tests and the blood flow problems that you have.

If intermittent claudication is severely limiting your lifestyle and affecting your quality of life, your healthcare team may offer bypass surgery. This will be an option for you only if previous angioplasty surgery was unsuccessful or if angioplasty is unsuitable for you, and the results of the imaging tests show that bypass surgery is an appropriate treatment.

If a supervised exercise programme has not improved your symptoms sufficiently and you prefer not to have angioplasty or bypass surgery, your healthcare team may offer you treatment with a drug called naftidrofuryl oxalate, which works by widening the blood vessels. Your symptoms should be checked after 3–6 months, and the drug treatment should be stopped if your symptoms are not improving.

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Category: Options

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