Depending on the severity of the<unk> , these steps can be taken, according to these guidelines: Lifestyle * Stopping smoking (cigarettes promote<unk>  and are a risk factor for cardiovascular<unk>  * Regular exercise for those with claudication helps open up alternative small vessels (collateral flow) and the limitation in walking often improves. Treadmill exercise (35 to 50 minutes, three or four times per week) has been reviewed as another treatment with a number of positive outcomes, including reduction in cardiovascular events and improved quality of life. Supervised exercise programs increase pain-free walking time and the maximum walking distance in people with<unk> . Medication * Management of diabetes * Management of hypertension * Management of high cholesterol, and antiplatelet drugs such as aspirin and clopidogrel. Statins reduce clot formation and cholesterol levels, respectively, can help with<unk>  progression, and address the other cardiovascular risks that the affected person is likely to have. According to guidelines, taking aspirin or clopidogrel is recommended to reduce AMI ("heart attack"), stroke, and other causes of vascular death in people with symptomatic<unk> . It is recommended that aspirin and clopidogrel be taken alone and not in conjunction with one another (i.e., not as dual antiplatelet therapy). The recommended daily dosage of aspirin for treating<unk>  is between 75 and 325 mg, while the recommended daily dosage for clopidogrel is 75 mg. The effectiveness of both aspirin and clopidogrel to reduce risk of cardiovascular ischemic events in people with symptomatic<unk>  is not well established. Research also suggests that low-dose rivaroxaban plus aspirin is effective as a new anti-thrombotic regimen for<unk> . Cilostazol can improve symptoms in some. Pentoxifylline is of unclear benefit. Cilostazol may improve walking distance for people who experience claudication due to<unk> , but no strong evidence suggests that it improves the quality of life, decreases mortality, or decreases the risk of cardiovascular events. Treatment with other drugs or vitamins are unsupported by clinical evidence, "but trials evaluating the effect of folate and vitamin B12 on hyperhomocysteinemia, a putative vascular risk factor, are near completion". Revascularization After a trial of the best medical treatment outline above, if symptoms persist, patients may be referred to a vascular or endovascular surgeon. The benefit of revascularization is thought to correspond to the severity of ischemia and the presence of other risk factors for limb loss such as wound and infection severity. * 3D Medical Animation still shot depicting the Vascular Bypass Grafting Angioplasty (or percutaneous transluminal angioplasty) can be done on solitary lesions in large<unk> es, such as the femoral<unk> , but may not have sustained benefits. Patency rates following angioplasty are highest for iliac<unk> es, and decrease with<unk> es towards the toes. Other criteria that affect outcome following revascularization are length of lesion and number of lesions. There does not appear to be long term advantages or sustained benefit to placing a stent following angioplasty in order to hold the narrowing of the subsartorial<unk>  open. * Atherectomy, in which the plaque is scraped off of the inside of the vessel wall (albeit with no better results than angioplasty). * Vascular bypass grafting can be performed to circumvent a<unk> d area of the<unk> al vasculature. The great saphenous vein is used as a conduit if available, although artificial (Gore-Tex or PTFE) material is often used for long grafts when adequate venous conduit is unavailable. * When gangrene has set in, amputation may be required to prevent infected tissues from causing sepsis, a life-threatening illness. * Thrombolysis and thrombectomy are used in cases of<unk> al thrombosis or embolism. Guidelines A guideline from the American College of Cardiology and American Heart Association for the diagnosis and treatment of lower extremity, renal, mesenteric, and abdominal aortic<unk>  was compiled in 2013, combining the 2005 and 2011 guidelines. For chronic limb threatening ischemia the ACCF/AHA guidelines recommend balloon angioplasty only for people with a life expectancy of 2 years or less or those who do not have an autogenous vein available. For those with a life expectancy greater than 2 years, or who have an autogenous vein, bypass surgery is recommended.
Peripheral artery disease
Lumbar spinal stenosis
Chronic venous insufficiency
Varicose veins
Diabetic foot
Spinal stenosis
Diabetic foot ulcer
Raynaud syndrome