Peripheral Arterial Disease: Should I Have 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 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.

High cholesterol, high blood pressure, and smoking add to plaque buildup and PAD.

Treatment for PAD is a combination of healthy lifestyle changes and medicines to ease symptoms and lower your risk of a heart attack and stroke. If you still have symptoms, you may choose to have angioplasty or surgery.

Lifestyle changes and medicine can help you live longer. Angioplasty or bypass surgery alone will not.

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

• If you smoke, quit. It's one of the most important things you can do. If you need help, talk to your doctor about programs and medicines that can help you stop.
• Have a heart-healthy lifestyle by eating healthy foods, getting regular exercise, and staying at a healthy weight.
• Manage other health problems such as diabetes, high blood pressure, and high cholesterol.
• Take medicine, such as aspirin, to 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. Each day, you try walking farther before the pain starts. Your doctor might recommend a supervised program or a program that you can do by yourself at home.
• A medicine, called cilostazol, can relieve pain that comes on with activity.

There are two types of procedures: angioplasty and bypass surgery.

• Angioplasty. Angioplasty is a less invasive procedure than surgery. Your doctor inserts a catheter into a blood vessel in your groin and guides it to the affected artery. When the catheter reaches the narrowed part of the artery, the surgeon inflates a balloon. The balloon presses the plaque against the wall of the artery. This improves blood flow. Angioplasty may be preferred for people who have a small number of short, narrowed areas in the arteries of the leg or pelvis.
• 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. Bypass surgery may be preferred for smaller arteries or when angioplasty is not likely to be successful. 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.

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 bypass surgery depends on the:

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

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

Risks of bypass surgery 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 bypass 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.
• Exercise has not relieved your symptoms.
• Medicines have not relieved your symptoms.