Health Essentials: How to Treat Your Peripheral Artery Disease

Your options for treating peripheral artery disease (PAD)are expanding. That’s good news – if we only knew which ones were best.

First, some background on PAD

PAD is when plaque builds up in arteries that carry blood to your legs. Plaque buildup can restrict your circulation. If it becomes severe, you may develop wounds in your lower legs or feet, which can be very painful and make walking difficult. If left untreated, PAD puts you at risk for amputation.

Diet and exercise can help improve your blood flow. So can medication. In addition, there are several treatment options for severe PAD:

  • Balloon angioplasty. A catheter (thin tube) is inserted into the artery. A tiny balloon on the end of the catheter is inflated to flatten the plaque against the artery wall, widening the vessel and improving blood flow. The balloon is then deflated and removed.
  • Balloon angioplasty with stenting. A balloon catheter widens the artery and leaves behind a stent (mesh tube) to prevent the artery from closing or narrowing again.
  • Atherectomy. Physicians use a catheter with a device to remove plaque from the artery.
  • Bypass surgery. Surgeons reroute blood flow by implanting a new blood vessel to go around the blocked artery.

The newest treatment option for PAD

Adding to this list, in 2014, the U.S. Food and Drug Administration approved a new treatment option: a drug-coated balloon. This device is used to treat PAD instead of or in conjunction with balloon angioplasty.

After a balloon angioplasty widens a blood vessel, the first balloon is removed and a second, drug-coated balloon is inserted into the same location. The drug-coated balloon is inflated, allowing the medication to transfer to the wall of the artery. The medication can help stop an artery from re-narrowing in the future. After a short time, the balloon is deflated and removed.

This procedure is usually done in the catheterization lab, under local anesthesia. Most people go home the same day.

How effective are drug-coated balloons?

One study recently published in the Journal of the American College of Cardiology reported that one brand of drug-coated balloons performed better than regular balloon angioplasty. Artery blockages in patients’ legs were less likely to recur when they were treated with drug-coated balloons.

“At least in some cases, drug-coated balloons seem to be as effective as stents,” says Mehdi H. Shishehbor, DO, MPH, PhD, Director of Endovascular Services at Cleveland Clinic. That’s a strong statement, since many physicians have considered stents to be the gold standard for treating blocked arteries in the leg.

But don’t assume drug-coated balloons are best for everyone, he notes.

“There are few research studies comparing PAD treatment options head to head,” says Dr. Shishehbor. “As such, there is little consensus in the medical community about which one is best. It does appear, however, that balloon angioplasty alone is not as good an option and should rarely be used to treat PAD by itself.”

Choosing the right treatment

The addition of drug-coated balloons – and even newer treatment options still on the horizon – may eventually mean better outcomes for people with PAD. But it’s still a challenge to determine the right treatment for each patient.

“For now, the decision is based on each physician’s preference and each patient’s condition, including size of the artery and severity of the blockage,” says Dr. Shishehbor. “More research should be done to compare all treatment options before we can conclude which ones are safest and most effective.”

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