3 Table 2. Eliminating elements that decrease circulation, such as crossing of legs while sitting, ill-fitting shoes, and tight clothing. Treatment for patients with overt signs and symptoms is aimed at retarding disease progression and increasing collateral blood flow. Before initiating pharmacotherapy, preventive measures and lifestyle changes should be attempted first. If lifestyle changes prove ineffective, pharmacotherapy should be initiated, although the use of pharmacotherapy to treat peripheral arterial disease is limited.
Vasodilators complicate blood flow to ischemic tissue by several proposed mechanisms.
Long-term tissue ischemia can initiate the development of additional collateral vessels to assist the atherosclerotic vessels in tissue perfusion. The acute release of vasodilatory substances will cause dilation in both the atherosclerotic and collateral vessels. Vasodilators in combination with vasodilatory substances will result in excessive vasodilation, which dramatically decreases tissue perfusion pressure to worsen the signs and symptoms of peripheral arterial disease. Since vasodilators produce an overall decrease in peripheral vascular resistance, this further adds to decreasing tissue perfusion by reducing systemic blood pressure. In addition, excessive vasodilation of the larger arteries causes an increased demand for blood, which competes for and reduces blood flow to ischemic tissue.