Peripheral Arterial Disease: Should I Have a Procedure or Surgery?

Peripheral arterial disease (PAD) is a narrowing or blockage of arteries in your arms and legs. It causes poor blood flow. When you walk or exercise, your leg muscles don't get enough blood. This may cause symptoms, such as leg pain during exercise.

PAD is typically caused by plaque buildup on the inside of arteries. Plaque is made of extra cholesterol and calcium in your blood. Over time, plaque builds up in the walls of the arteries, including those that supply blood to your legs.

Poor blood flow may cause intermittent claudication. This is tightness or squeezing pain in the calf, thigh, or buttock during exertion, such as walking up a steep hill or a flight of stairs.

Smoking, diabetes, high cholesterol, and high blood pressure add to plaque buildup and PAD.

Treatment for PAD includes a heart-healthy lifestyle and medicines to slow the progress of the disease and lower your risk of a heart attack and stroke. If you have symptoms, medicine or a specialized exercise program may ease your symptoms. If you still have symptoms, you may choose to have angioplasty or surgery.

A heart-healthy lifestyle and medicine can help prevent a heart attack and stroke. Angioplasty or surgery alone will not.

If you have angioplasty or surgery, you will still need to have a heart-healthy lifestyle and take medicine for the best long-term results.

• Try to quit or cut back on using tobacco and other nicotine products. This includes smoking and vaping. If you need help quitting, talk to your doctor about stop-smoking programs and medicines.
• Have a heart-healthy lifestyle by eating healthy foods, getting regular exercise, getting a healthy amount of sleep, and staying at a weight that's healthy for you.
• Manage other health problems such as diabetes, high blood pressure, and high cholesterol.
• Take medicine to help prevent blood clots.

A specialized exercise program or medicine may help relieve symptoms and help you walk more easily.

• The exercise program can increase the amount of time you can exercise before you have pain. In each session, you walk until the pain starts, then rest until it goes away. You work to increase how long you can walk without pain. Your doctor might recommend a supervised program or a program that you can do by yourself at home. Over the long term, and depending on the severity of the disease, you may gain as much benefit from an exercise program as from surgery.^{footnote 1}
• A medicine, called cilostazol, can relieve pain that comes on with activity.

Procedures and surgeries include angioplasty, bypass surgery, and endarterectomy.

• Angioplasty. Angioplasty is a less invasive procedure than surgery. Your doctor inserts a thin tube called a catheter into a blood vessel and guides it to the affected artery. When the catheter reaches the narrowed part of the artery, the doctor inflates a balloon. The balloon presses the plaque against the wall of the artery. This improves blood flow. An expandable tube called a stent might be placed in the artery to help keep it open.
• Bypass surgery. This surgery helps blood make a detour, or bypass, around one or more narrowed or blocked arteries. The type of surgery used depends on the affected leg artery or arteries. The types of bypass surgeries are:
  • Aortobifemoral bypass, for the aorta and the iliac arteries.
  • Femoropopliteal (fem-pop) bypass, for the arteries in the thigh and knee.
  • Femoral-tibial bypass, for the arteries in the lower leg or foot.
• Endarterectomy. This surgery removes plaque from the blood vessel. It's most often done on the large artery in your groin and upper thigh area (femoral artery).

More than one type of procedure may be done at the same time. For example, a bypass surgery may be done at the same time as a less invasive angioplasty. These procedures may be done at the same time to treat different levels of disease and different-sized arteries.

The choice of angioplasty or surgery depends on the:

• Risks of the procedure.
• Size of the arteries.
• Number and length of the narrowing or blockages in the arteries.

All procedures and surgeries have risks. Angioplasty has fewer life-threatening risks than surgery.

Risks of surgery depend on the type and location of the surgery. Examples of risks include:

• Infection.
• Bleeding.
• Heart attack or stroke.
• Leg swelling.
• Failed or blocked grafts.

Risks of angioplasty include:

• Rupture of the artery.
• Bleeding at the site where the catheter goes in.
• Sudden closure of the artery.
• Blood clots.
• Allergic reaction.
• Kidney damage.

The worse your disease, the more likely you are to benefit from angioplasty or surgery. Your doctor might advise you to have one of these procedures if you have intermittent claudication and any one of these problems:

• Symptoms limit your lifestyle or job.
• An exercise program has not relieved your symptoms.
• Medicine has not relieved your symptoms.