Treatment begins by controlling the possible underlying causes of the PAD. It is important that patients make any changes they can in order to slow the progression of the atherosclerosis. For example, quitting smoking is seen as the single most important controllable risk factor. For people with diabetes who have PAD, keeping blood pressure under control can be challenging. The American Heart Association recommends a blood pressure lower than 120/80 mmHg (millimeters of mercury) for individuals with diabetes, in order to help reduce the risk of heart attack.

Other risk factors that can be modified include:

• Lack of regular exercise
• Eating a diet high in fat
• Oobesity
• Uncontrolled diabetes
• Hhypertension
• Chronic stress or anger
• High LDL cholesterol and low HDL cholesterol.

In many cases, controlling risk factors is enough to treat the disease. Unlike most other forms of PAD, treatment of PAD of the lower extremities is based almost entirely on the relief of symptoms, especially intermittent claudication (pain in the legs while exercising).

However, if the claudication is disabling, or if advanced symptoms are present, the physician may consider a more aggressive treatment. Treatment is typically indicated for patients experiencing any of these symptoms:

If intervention is necessary, physicians may use any or all of the following approaches to treat PAD of the lower extremities:

• Exercise and medical therapy (medications)
• Endovascular (catheter-based) treatments to increase leg blood flow
• Surgical treatments to increase leg blood flow