• Lose your Kools: Get him to quit smoking.  It may not improve his walk distance, but it will prevent him from losing that leg and having the heart attack that’s coming.

• Watch the numbers: These patients are a CV risk equivalent, so treat them that way. BP and Lipid goals are the same as they would be for someone with known CAD.

• Stop the clot:  Take an aspirin. See above- mostly for prevention of CAD and CVD.  There has been a study (CAPRIE) to compare aspirin with Plavix, and Plavix may actually be more effective at preventing limb ischemia, however comes with higher risk. 

• Make them feel better (oh yeah, that):  A few things that might improve their walk distance and quality of life:

• Move it or Lose it.  There is a lot of evidence that exercise helps, but hard to operationalize, like most behavioral interventions.  But, certainly worth talking to your patient about a paced exercise program.  Simple- walk until it hurts, rest, walk some more.  Keep doing this- you will be able to walk farther each time.  

• Cilostazol: inhibits platelet aggregation, vascular smooth muscle proliferation, and causes dilatation.  Improves walking distance, quality of life, and maybe even improves ABIs.

• Warm up the OR:  Time for surgery if his function declines despite the above measures, or if he develops ulcer or other sign of limb ischemia.  

Here’s an article for more: Peripheral Vascular Disease NEJM 2007