What’s most important about having peripheral artery disease (PAD) isn’t the PAD itself -- it’s what it says about your risk for other, life-threatening conditions.
Cynthia Shortell, MD, head of vascular surgery at Duke, says that being diagnosed with PAD means one thing for certain: you’ve got atherosclerosis -- otherwise known as hardened arteries. “And you should definitely seek treatment and evaluation for that,” she says, as it’s a major risk factor for heart disease and stroke.
But she says that PAD is not, in and of itself, a condition that requires aggressive treatment in all people. Choosing treatment (or not) often depends on how much your symptoms interfere with your life.
In those with mild to moderate symptoms, Shortell says three therapies are most often recommended:
- Smoking cessation: better blood flow in the limbs is one of many benefits to smokers who quit.
- An exercise routine, which can be as simple as a daily walk, is a very effective way to build new vessels and improve circulation -- when the routine is maintained, of course.
- In some patients, medications can be useful, but they do have important side effects that should be weighed carefully with your physician.
For people with severe symptoms -- persistent, debilitating leg pain or wounds that won’t heal -- surgical procedures can open up the blocked veins. These are similar to the procedures used to open blood vessels in patients with advanced heart disease: opening a blocked vein by placing a balloon or stent into the vessel, or performing a bypass, using vein taken from the patient’s thigh.
Shortell says that for most patients with claudication, deciding to have one of these surgical procedures is not unlike the decision to have knee replacement surgery. “It’s a quality-of-life decision,” she says.
The effects are long-lasting, but not permanent -- so in younger patients, or patients who have health problems that may require a bypass surgery later on, physicians often advise delaying extensive surgical treatment for as long as possible.
“We usually reserve bypass for very severe cases -- such as those where, if you don’t do something, the patient may lose his leg.” But she notes that very few people -- fewer than 5 percent -- will actually lose a limb due to PAD. Diabetes, kidney disease, and smoking are the main reasons that PAD could become a limb -- and life -- threatening condition.