The treatment of peripheral artery disease

Peripheral artery disease (PAD) is caused by atherosclerosis and could present itself through various symptoms. Intermittent claudication is the most prevalent symptom and is defined as a cramping pain in calf, thigh or buttock muscles during walking that is relieved upon a short period of rest. The prevalence of intermittent claudication is approximately 3% among people older than 55 years and 14% among people over 70 years old. Important risk factors for PAD are smoking, an inactive lifestyle and an unhealthy diet. 

Several studies show that supervised exercise therapy (SET) is a cost-effective treatment for patients with intermittent claudication. Therefore, the majority of PAD guidelines recommend a ‘stepped-care model’. According to this model, care will ideally be organized as follows: The general practitioner provides care in the context of cardiovascular risk management and refers the patient to a specialized ClaudicatioNet physiotherapist for SET and lifestyle counselling. Only if the progress of the conservative treatment is insufficient or if symptoms (severely) increase, the general practitioner will refer the patient to a vascular surgeon for further diagnosis and treatment. This ‘stepped care’ approach ensures that patients will only receive a more invasive treatment (i.e. percutaneous transluminal angioplasty or surgical bypass) if necessary. Additionally, this will result in fewer healthcare costs.

The combination of supervised exercise therapy and lifestyle counselling is an intensive treatment process of approximately one year. It initially consists of two or three treatment sessions per week, with the frequency gradually decreasing to once every month. The process ultimately aims towards self-management, with patients living a healthier lifestyle and being more active on their own, without supervision from a ClaudicatioNet physiotherapist. The treatment sessions exist of exercise therapy to increase the walking distance and improve the quality of life. During these sessions, the physiotherapist additionally addresses any relevant comorbidities or other restrictive factors. As a consequence, not only the affected leg is treated, but also the overall health and wellbeing of the patient is influenced beneficially. All ClaudicatioNet physiotherapists complete extra training in lifestyle counselling to ensure that the most important risk factors (smoking, an inactive lifestyle and an unhealthy diet) are always addressed during the treatment process.