Do I Really Need Surgery for Peripheral Artery Disease?

For the first time in what seems like ages, Judith Taylor sleeps nonstop. She is not awakened by pain or numbness in her feet caused by Peripheral Arterial Disease (PAD) which she was diagnosed with 3 years ago. She didn’t need an extra blanket and socks to keep her left foot warm, which had the worst circulation.

“That foot was so cold it woke me up in the middle of the night,” says Taylor, 68, a pastor in Shreveport, LA. “Now it’s the foot that keeps the other warm.”

As one of more than 8.5 million Americans with PAD – a narrowing or blockage of the arteries that supply the extremities, most often the legs – Taylor has found relief through angioplasty. Whether to do so was not even a question: his blockage was severe; pain and discomfort interrupted his sleep and his life.

Taylor has had two procedures in 2 years. Each involved the placement of stents; she spent several days in the hospital.

The first kept his artery clear for a year; the second for 8 months. The most recent procedure was an angioplasty which involved the insertion of two balloons and a stent into her leg. She returned home that same evening and felt better almost immediately.

But the procedure is not a good choice for everyone with the condition. Each case is his; there is no general treatment plan.

PAD treatments vary

“You need to see your doctor because treatment for PAD will be different for everyone,” says Sarah Samaan, MD, a cardiologist at Baylor Scott & White The Heart Hospital in Plano, TX.

“For some mild cases, walking can improve it and that’s fine,” Samaan says. “But you have to take stock, find out what you are dealing with, what kind of blockage there is and how serious it is.”

For mild cases, risk reduction pharmacology may be sufficient, said Matthew Corriere MD, vascular surgeon at the Frankel Cardiovascular Center at the University of Michigan Health.

“They may not have symptoms,” Corriere says, “but they’re still at increased risk for heart attack and stroke. We put them on low dose aspirin and a statin. This decreases the risk of progression of PAD, but also lowers the risks of coronary heart disease and stroke.

For them, there would be no point in having an operation or undergoing a less invasive procedure. They feel good; they manage their chronic disease.

From the onset of the disease, doctors emphasize the importance of these key elements:

  • Quitting smoking, the main cause of PAD
  • Controlling Diabetes
  • Start an exercise routine

But if the pain and discomfort worsens and PAD increasingly interferes with daily life, other options are also on the table.

When the PAD reaches a tipping point

“The tipping point for whether or not to take the next step could be pain symptoms that don’t go away and limit their quality of life,” says Samaan. “Non-healing wounds on the legs would be another, leading to a procedure or operation to restore blood flow.”

Some situations, such as chronic ischemia threatening the limbs, leave little choice of care. Patients can be in pain all the time, Corriere says. Perhaps they have a foot ulcer that poor circulation prevents from healing and that has resulted in gangrene on one or more of their toes.

“With these patients, we have to do a procedure,” says Corriere. “Their limitation in blood flow is much more severe. We try to do revascularization if we can – angioplasty or a stent or bypass. “

Especially if the symptoms are ignored for too long, “there can be damage so severe and irreversible that a patient can lose a toe, a foot or even part of a leg,” says Samaan.

Care is tailored to a patient’s specific situation: symptoms, size and type of lesion, and location of the blockage, Corriere explains. He has done extensive research on shared decisions between people with PAD and doctors.

“What we are seeing is that individual patients have different goals and expectations,” says Corriere. “Sometimes they are in accordance with medical recommendations and sometimes they are not. Some patients are risk averse. If they learn that their blockage won’t get worse with what they’re already doing, they’ll be happy to have mild symptoms and be left alone.

“Others want anything that can be done. Sometimes we do and sometimes we have to set mutual expectations.

Many PAD procedures, such as Taylor’s most recent angioplasty, do not require overnight hospitalization and results are immediate. After that, all you need to do is limit your activities for a few days.

For revascularization surgery, you can spend 2-4 nights in the hospital. Recovery is slower and likely involves being seen by a physiotherapist.

Not a cure

Corriere would like people with PAD to remember this: No matter what treatment they receive, it is not a cure.

“I see people who don’t get counseling on the chronic nature of PAD and come to me because they’ve had a stent in their leg for 5 years and now have issues with it,” Corriere says. “They tell me they thought it was cured. But he’s never healed; we face it.

For Judith Taylor (who is neither a Corriere nor Samaan patient), it’s okay. She can sleep through the night; she can walk painlessly. And she is determined to do whatever she can to stay the course.

“It’s up to me to keep this artery open,” Taylor says. “With this blockage I had, I could have lost my leg,” she said. “You have to walk every day, and I can do it. Keep walking and the ships stay cleaner. I am motivated to get out of this pain.

Above all, “Don’t give up. To ask questions. Do your part as a patient, ”says Taylor. “We all have something we can do to work with our medical team, if only to be careful and let them know what’s going on.”

“I felt better almost immediately,” Taylor says. “You can’t imagine how good my morale is. You try to be friendly and upbeat all the time. But constantly suffering really takes a lot out of you.

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