Peripheral Arterial Occlusive Disease Treatment & Management

  • Author: Vincent Lopez Rowe, MD; Chief Editor: Vincent Lopez Rowe, MD   more...
 
Updated: Aug 10, 2011
 

Medical Care

Treatment of claudication is medical, with surgery reserved for severe cases.

  • The goal of medical management is to impede the progression of peripheral arterial occlusive disease (PAOD).
    • In patients who smoke, the most expedient way to impede the progress of PAOD is to stop tobacco use.
    • Extensive evidence indicates that smoking cessation improves the prognosis.
    • Improved walking distance and ankle pressure have been attributed to smoking cessation.
  • Exercise plays a vital role in the treatment of claudication.
    • Patients reduce their daily walking because of claudication pain and fear of further damage. This leads to an increasingly sedentary lifestyle that is even more detrimental.
    • Regular walking programs result in substantial improvement in most patients with claudication. Improvements have ranged from 80-234% in controlled studies.
    • A daily walking program of 45-60 minutes is recommended. The patient is instructed to walk until claudication pain occurs, rest until the pain subsides, and repeat the cycle.
    • While the exact mechanism for improvement in walking distance with exercise remains unknown, regular exercise is thought to condition muscles to work more efficiently (more extraction of blood) and increase collateral vessel formation.
  • Additional medical treatment includes control of the lipid profile, diabetes, and hypertension.
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Surgical Care

Patients with limb-threatening ischemia or lifestyle-limiting claudication are referred to a vascular surgeon. Only then does evaluation warrant an arteriogram.

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Consultations

See Surgical Care.

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Contributor Information and Disclosures
Author

Vincent Lopez Rowe, MD  Associate Professor of Surgery, Department of Surgery, Division of Vascular Surgery, University of Southern California Medical Center

Vincent Lopez Rowe, MD is a member of the following medical societies: American College of Surgeons, American Heart Association, Pacific Coast Surgical Association, Peripheral Vascular Surgery Society, Society for Clinical Vascular Surgery, Society for Vascular Surgery, and Western Vascular Surgical Society

Disclosure: Nothing to disclose.

Specialty Editor Board

William H Pearce, MD  Chief, Division of Vascular Surgery, Violet and Charles Baldwin Professor of Vascular Surgery, Department of Surgery, Northwestern University, The Feinberg School of Medicine

William H Pearce, MD is a member of the following medical societies: American College of Surgeons, American Heart Association, American Surgical Association, Association for Academic Surgery, Association of VA Surgeons, Central Surgical Association, New York Academy of Sciences, Society for Vascular Surgery, Society of Critical Care Medicine, Society of University Surgeons, and Western Surgical Association

Disclosure: Nothing to disclose.

Francisco Talavera, PharmD, PhD  Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Medscape Salary Employment

Travis J Phifer, MD  Chief, Division of Vascular Surgery, Professor, Department of Surgery and Radiology, Louisiana State University Health Sciences Center in Shreveport

Travis J Phifer, MD is a member of the following medical societies: American College of Emergency Physicians, American College of Surgeons, American Medical Association, Association for Academic Surgery, Society for Academic Emergency Medicine, Society for Vascular Surgery, and Society of Critical Care Medicine

Disclosure: Nothing to disclose.

Paolo Zamboni, MD  Professor of Surgery, Chief of Day Surgery Unit, Chair of Vascular Diseases Center, University of Ferrara, Italy

Paolo Zamboni, MD is a member of the following medical societies: American Venous Forum and New York Academy of Sciences

Disclosure: Nothing to disclose.

Chief Editor

Vincent Lopez Rowe, MD  Associate Professor of Surgery, Department of Surgery, Division of Vascular Surgery, University of Southern California Medical Center

Vincent Lopez Rowe, MD is a member of the following medical societies: American College of Surgeons, American Heart Association, Pacific Coast Surgical Association, Peripheral Vascular Surgery Society, Society for Clinical Vascular Surgery, Society for Vascular Surgery, and Western Vascular Surgical Society

Disclosure: Nothing to disclose.

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Peripheral arterial occlusive disease. Measuring segmental pressures.
Peripheral arterial occlusive disease. This angiogram shows a superficial femoral artery occlusion on one side (with reconstitution of the suprageniculate popliteal artery) and superficial femoral artery stenosis on the other side. This is the most common area for peripheral vascular disease.
 
 
 
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