If you are a smoker, seeing your physician and working with professionals to eliminate cigarette smoking is critical. The combination of abstinence from smoking and walking to and beyond tolerance can result in one to three fold improvements in exercise tolerance. This probably occurs by the opening of collateral circulatory pathways which then supplement blood flow to the muscles of the lower extremity. The goal of walking 30 to 60 minutes per day for four to five days per week is appropriate. Having the patient measure a distance known to produce claudication and then extending that period of ambulation somewhat is recommended to maximize collateralization.
Pharmacological treatment can also be helpful.
Combined therapy may also have a role. Recently, double-blind studies comparing these two drugs have suggested superiority for Pletal which is now used in the pharmacological management of some patients. However, in patients whose activities of daily living are significantly impaired because of the symptoms of PAD, further investigations and interventions may be justified. Clearly, if the limb is threatened by rest pain, non-healing ulceration, or gangrene, the specialist will need to consider a procedure to improve blood supply which could include angioplasty and stenting or surgical bypass. Arteriograms involve the injection of a contrast liquid which can be seen using X-ray techniques and should be used only when intervention is planned.