How can I prevent peripheral vascular disease?
Peripheral vascular disease increases with age and from the progression of atherosclerosis from dyslipidemia, tobacco products, diabetes and hyperglycemia, obesity, and a sedentary lifestyle.
The progressive stenosis and occlusion, thrombus formation, or embolism of plaques or thrombi result in claudication, rest pain, and ulceration. Ulceration increases the risk of both local and systemic infection. Gangrene is the ultimate end-result, leading to amputation and life-threatening infection. Prevention is via mitigation of the risk factors other than age.
- Dyslipidemia and lipid-lowering therapy: alterations in diet and exercise and, when necessary, statin medication, to set goals of total cholesterol <200; LDL-C <130; and triglycerides <150
- Smoking cessation
- Management of hypertension with lifestyle changes (diet, exercise) and when necessary, anti-hypertensive medication.
- Hyperglycemia: strict glycemic control, especially in diabetic patients.
- Antiplatelet therapy with aspirin or clopidogrel (Plavix).
- Supervised exercise for claudication (exertional extremity pain).
- Avoidance of medication that enhances hypercoagulation, such as estrogens in birth control pills or menopausal hormone replacement.
- Counseling with a mental health professional to identify causes of poor health choices and how best to change them.
- Weight loss: counseling with a dietitian/nutritionist is an important adjunct to the above measures and assures valid information upon which to base an individualized diet with reasonable expectations.
- Revascularization: once there is ischemic pain at rest, progression will continue until amputation unless there is intervention to improve perfusion, such as minimally invasive endovascular procedures (percutaneous) or open surgery.