So your patient can’t walk to the mailbox anymore. “Doc, I have to stop once I get there, and rest 5 minutes before I can move on back to the house.”
You check, and sure enough ABIs are <1 on both sides.
So you’ve made the diagnosis, now what? How can you improve your patient’s quality of life, and prevent loss of life and limb?
- 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