Peripheral arterial disease: Should I have surgery?

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Peripheral arterial disease: Should I have surgery?

You may want to have a say in this decision, or you may simply want to follow your doctor's recommendation. Either way, this information will help you understand what your choices are so that you can talk to your doctor about them.

Peripheral arterial disease: Should I have surgery?

Get the facts

Your options

  • Have angioplasty or bypass surgery.
  • Try lifestyle changes, medicines, and exercise to reduce leg pain.

Key points to remember

  • Your doctor may advise you to try lifestyle changes before you think about angioplasty or bypass surgery. Making these changes could help you walk without pain. And they don't have the risks of bypass surgery or angioplasty.
  • Lifestyle changes such as quitting smoking and eating better could help you live longer. Angioplasty or bypass surgery alone will not. You will still need to make these changes for the best long-term results.
  • You may want to have one of these procedures if you are not able to do daily activities. They may be a good choice for you if you want relief from leg pain right away.
  • If you have severe peripheral arterial disease, having one of these procedures may save your leg.
FAQs

What is peripheral arterial disease?

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 and you can get painful cramps.

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 along the inner 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.

How is peripheral arterial disease treated?

Lifestyle changes and medicine often can stop plaque buildup. They can improve the quality and length of your life. Many people have less leg pain after trying these treatments for several months.

If you smoke, quitting is the best thing you can do when you have peripheral arterial disease (PAD). Smoking makes your symptoms worse. It also increases the chances of amputation and other problems.

Nicotine replacement products, medicines, and counselling can double your chances of quitting.1 Medicines include bupropion, nortriptyline, and varenicline (Champix).

Your doctor also will strongly advise you to:

You will probably need to take cholesterol-lowering medicines. People with diabetes should try to keep their blood sugar levels in a target range.

People with PAD who have intermittent claudication have a higher risk for early death than other people the same age. ASA and strict blood pressure control can reduce this risk.

If you still have symptoms after making these changes, you may need angioplasty or bypass surgery. But you will still need to make lifestyle changes for the best long-term results.

What kinds of procedures are done for peripheral arterial disease?

There are two types of procedures:

  • Angioplasty . The surgeon puts a small, thin tube called a catheter through a blood vessel in your groin and guides it to the affected artery. When the tube 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. A small tube called a stent often is placed in the artery to hold it open.
  • Bypass surgery. This surgery helps blood make a detour, or bypass, around one or more blocked arteries. The type of surgery used depends on the affected leg artery or arteries. You may have:

Bypass surgeries can be done with a vein or with a man-made graft. Vein grafts can keep the blood vessel open longer than the man-made grafts.

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.

A less common surgery is called an endarterectomy. An endarterectomy is typically done on the large femoral artery, which is in your groin and upper thigh area. This surgery is done to remove fatty buildup (plaque) and to increase blood flow to the leg. This surgery is done by cutting open the femoral artery and removing the plaque. This surgery may be done by itself, or it may be done at the same time as bypass surgery or angioplasty.

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.

For example:

  • Angioplasty works best in larger arteries. It has the best rates of success in the aorta and iliac arteries.
  • In the femoral arteries, angioplasty works better if the area that is narrowed is short.
  • Angioplasty has become more common for problems in the popliteal and tibial arteries. In the past, doctors preferred bypass surgery over angioplasty in these arteries.

What are the risks of these procedures?

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

Risks of bypass surgery include:

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.

Why might your doctor recommend having a procedure?

The worse your disease, the more likely you are to need 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.

Compare your options

Compare

What is usually involved?









What are the benefits?









What are the risks and side effects?









Have angioplasty or bypass surgery Have angioplasty or bypass surgery
  • With angioplasty, you stay in bed for 6 to 8 hours after the procedure. You may have to stay overnight in the hospital.
  • When you leave the hospital after angioplasty, you can most likely return to normal activities.
  • Depending on the type of bypass surgery, you will spend 1 to 4 days in bed after surgery. You will be in the hospital for 3 to 7 days.
  • You will still need to make lifestyle changes and take medicines.
  • Either of these procedures will restore blood flow and relieve leg pain right away.
  • Angioplasty or bypass surgery can increase your ability to walk.
  • Having one of these procedures can prevent you from losing your leg.
  • 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.
Try lifestyle changes, exercise, and medicine Try lifestyle changes, exercise, and medicine
  • You quit smoking.
  • You make other lifestyle changes, such as eating better and exercising.
  • You take medicine as prescribed by your doctor.
  • You watch for foot or leg sores, and you treat them right away. These sores may be slow to heal because of poor blood supply.
  • Over the long term, you may gain as much benefit from an exercise program as from surgery.
  • Making lifestyle changes and taking medicines can help you live longer.
  • It may take up to a year to see the benefits of lifestyle changes.
  • Your disease may get worse. You may still need to have angioplasty or bypass surgery.

Personal stories

Are you interested in what others decided to do? Many people have faced this decision. These personal stories may help you decide.

Personal stories about peripheral arterial disease

These stories are based on information gathered from health professionals and consumers. They may be helpful as you make important health decisions.

I just took up walking after recently retiring, and I would enjoy it if my legs didn't ache so much. My doctor says I can have angioplasty, which is not as complicated as surgery. I think I'll go ahead so that I can continue doing the things I enjoy doing.

Julio, age 68

I've known for a long time that I should quit smoking and take better care of myself. My doctor told me that if I didn't, I might lose a foot someday and have to give up driving a truck. That's enough to make me change my ways. I'm going to give it my best.

Nancy, age 55

I live in the middle of a big city. It's too dangerous to get out and walk regularly. I'm going to try the surgery and see if my leg pain gets better.

Jackson, age 64

I don't like hospitals. I'm going to try the medicine and other recommendations my doctor made so that I won't have to have surgery. I've started walking a little more every day, and I'm watching what I eat. I know it will be a long road, but it's worth a try.

Clovis, age 66

For more information, see the topic Peripheral Arterial Disease of the Legs.

What matters most to you?

Your personal feelings are just as important as the medical facts. Think about what matters most to you in this decision, and show how you feel about the following statements.

Reasons to have surgery for peripheral arterial disease

Reasons to try lifestyle changes and medicines first

I want to be able to walk without pain now.

I can wait until I see the benefits of my exercise program.

More important
Equally important
More important

I accept the risks of surgery.

I want to avoid surgery.

More important
Equally important
More important

If I can't cure my disease with lifestyle changes, I may as well have surgery.

I want to try lifestyle changes to see if I can improve my condition before I think about surgery.

More important
Equally important
More important

My disease is very bad, and I don't want to lose my leg.

My disease is not that serious yet.

More important
Equally important
More important

I'm committed to quitting smoking so that my surgery has the best chance of success.

I'm not ready to quit smoking.

More important
Equally important
More important

My other important reasons:

My other important reasons:

More important
Equally important
More important

Where are you leaning now?

Now that you've thought about the facts and your feelings, you may have a general idea of where you stand on this decision. Show which way you are leaning right now.

Having surgery

Trying lifestyle changes and medicines first

Leaning toward
Undecided
Leaning toward

What else do you need to make your decision?

Check the facts

1.

Having angioplasty or bypass surgery will allow me to save my leg.

  • TrueThat's right. If you have severe peripheral arterial disease, having one of these procedures may save your leg.
  • FalseSorry, that's not right. If you have severe peripheral arterial disease, having one of these procedures may save your leg.
  • I'm not sureIt may help to go back and read "How is peripheral arterial disease treated?" If you have severe peripheral arterial disease, having one of these procedures may save your leg.
2.

If I have angioplasty or bypass surgery, I don't need to quit smoking or make other lifestyle changes.

  • TrueSorry, that's not right. Quitting smoking, exercising, and making other lifestyle changes can help you live longer. Angioplasty and bypass surgery alone will not. You will still need to make these changes for the best long-term results.
  • FalseYou're right. Quitting smoking, exercising, and making other lifestyle changes can help you live longer. Angioplasty and bypass surgery alone will not. You will still need to make these changes for the best long-term results.
  • I'm not sureIt may help to go back and read "How is peripheral arterial disease treated?" You still need to make lifestyle changes even if you have angioplasty and bypass surgery.
3.

I can increase my ability to walk without pain if I start an exercise program and make other lifestyle changes.

  • TrueYou're right. An exercise program and other lifestyle changes can increase your ability to walk without pain.
  • FalseSorry, that's not right. An exercise program and other lifestyle changes can increase your ability to walk without pain.
  • I'm not sureIt may help to go back and read "What are the benefits?" in the "Compare your options" chart. An exercise program and other lifestyle changes can increase your ability to walk without pain.

Decide what's next

1.

Do you understand the options available to you?

2.

Are you clear about which benefits and side effects matter most to you?

3.

Do you have enough support and advice from others to make a choice?

Certainty

1.

How sure do you feel right now about your decision?

Not sure at all
Somewhat sure
Very sure
3.

Use the following space to list questions, concerns, and next steps.

Your Summary

Here's a record of your answers. You can use it to talk with your doctor or loved ones about your decision.

Your decision 

Next steps

Which way you're leaning

How sure you are

Your comments

Your knowledge of the facts 

Key concepts that you understood

Key concepts that may need review

Getting ready to act 

Patient choices

Credits and References

Credits
CreditsHealthwise Staff
Primary Medical ReviewerE. Gregory Thompson, MD - Internal Medicine
Specialist Medical ReviewerDavid A. Szalay, MD - Vascular Surgery

References
Citations
  1. Stead LF, et al. (2008). Nicotine replacement therapy for smoking cessation. Cochrane Database of Systematic Reviews (1).
You may want to have a say in this decision, or you may simply want to follow your doctor's recommendation. Either way, this information will help you understand what your choices are so that you can talk to your doctor about them.

Peripheral arterial disease: Should I have surgery?

Here's a record of your answers. You can use it to talk with your doctor or loved ones about your decision.
  1. Get the facts
  2. Compare your options
  3. What matters most to you?
  4. Where are you leaning now?
  5. What else do you need to make your decision?

1. Get the facts

Your options

  • Have angioplasty or bypass surgery.
  • Try lifestyle changes, medicines, and exercise to reduce leg pain.

Key points to remember

  • Your doctor may advise you to try lifestyle changes before you think about angioplasty or bypass surgery. Making these changes could help you walk without pain. And they don't have the risks of bypass surgery or angioplasty.
  • Lifestyle changes such as quitting smoking and eating better could help you live longer. Angioplasty or bypass surgery alone will not. You will still need to make these changes for the best long-term results.
  • You may want to have one of these procedures if you are not able to do daily activities. They may be a good choice for you if you want relief from leg pain right away.
  • If you have severe peripheral arterial disease, having one of these procedures may save your leg.
FAQs

What is peripheral arterial disease?

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 and you can get painful cramps.

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 along the inner 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.

How is peripheral arterial disease treated?

Lifestyle changes and medicine often can stop plaque buildup. They can improve the quality and length of your life. Many people have less leg pain after trying these treatments for several months.

If you smoke, quitting is the best thing you can do when you have peripheral arterial disease (PAD). Smoking makes your symptoms worse. It also increases the chances of amputation and other problems.

Nicotine replacement products, medicines, and counselling can double your chances of quitting.1 Medicines include bupropion, nortriptyline, and varenicline (Champix).

Your doctor also will strongly advise you to:

You will probably need to take cholesterol-lowering medicines. People with diabetes should try to keep their blood sugar levels in a target range.

People with PAD who have intermittent claudication have a higher risk for early death than other people the same age. ASA and strict blood pressure control can reduce this risk.

If you still have symptoms after making these changes, you may need angioplasty or bypass surgery. But you will still need to make lifestyle changes for the best long-term results.

What kinds of procedures are done for peripheral arterial disease?

There are two types of procedures:

  • Angioplasty . The surgeon puts a small, thin tube called a catheter through a blood vessel in your groin and guides it to the affected artery. When the tube 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. A small tube called a stent often is placed in the artery to hold it open.
  • Bypass surgery. This surgery helps blood make a detour, or bypass, around one or more blocked arteries. The type of surgery used depends on the affected leg artery or arteries. You may have:

Bypass surgeries can be done with a vein or with a man-made graft. Vein grafts can keep the blood vessel open longer than the man-made grafts.

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.

A less common surgery is called an endarterectomy. An endarterectomy is typically done on the large femoral artery, which is in your groin and upper thigh area. This surgery is done to remove fatty buildup (plaque) and to increase blood flow to the leg. This surgery is done by cutting open the femoral artery and removing the plaque. This surgery may be done by itself, or it may be done at the same time as bypass surgery or angioplasty.

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.

For example:

  • Angioplasty works best in larger arteries. It has the best rates of success in the aorta and iliac arteries.
  • In the femoral arteries, angioplasty works better if the area that is narrowed is short.
  • Angioplasty has become more common for problems in the popliteal and tibial arteries. In the past, doctors preferred bypass surgery over angioplasty in these arteries.

What are the risks of these procedures?

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

Risks of bypass surgery include:

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.

Why might your doctor recommend having a procedure?

The worse your disease, the more likely you are to need 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.

2. Compare your options

  Have angioplasty or bypass surgery Try lifestyle changes, exercise, and medicine
What is usually involved?
  • With angioplasty, you stay in bed for 6 to 8 hours after the procedure. You may have to stay overnight in the hospital.
  • When you leave the hospital after angioplasty, you can most likely return to normal activities.
  • Depending on the type of bypass surgery, you will spend 1 to 4 days in bed after surgery. You will be in the hospital for 3 to 7 days.
  • You will still need to make lifestyle changes and take medicines.
  • You quit smoking.
  • You make other lifestyle changes, such as eating better and exercising.
  • You take medicine as prescribed by your doctor.
  • You watch for foot or leg sores, and you treat them right away. These sores may be slow to heal because of poor blood supply.
What are the benefits?
  • Either of these procedures will restore blood flow and relieve leg pain right away.
  • Angioplasty or bypass surgery can increase your ability to walk.
  • Having one of these procedures can prevent you from losing your leg.
  • Over the long term, you may gain as much benefit from an exercise program as from surgery.
  • Making lifestyle changes and taking medicines can help you live longer.
What are the risks and side effects?
  • 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.
  • It may take up to a year to see the benefits of lifestyle changes.
  • Your disease may get worse. You may still need to have angioplasty or bypass surgery.

Personal stories

Are you interested in what others decided to do? Many people have faced this decision. These personal stories may help you decide.

For more information, see the topic Peripheral Arterial Disease of the Legs.

Personal stories about peripheral arterial disease

These stories are based on information gathered from health professionals and consumers. They may be helpful as you make important health decisions.

"I just took up walking after recently retiring, and I would enjoy it if my legs didn't ache so much. My doctor says I can have angioplasty, which is not as complicated as surgery. I think I'll go ahead so that I can continue doing the things I enjoy doing."

— Julio, age 68

"I've known for a long time that I should quit smoking and take better care of myself. My doctor told me that if I didn't, I might lose a foot someday and have to give up driving a truck. That's enough to make me change my ways. I'm going to give it my best."

— Nancy, age 55

"I live in the middle of a big city. It's too dangerous to get out and walk regularly. I'm going to try the surgery and see if my leg pain gets better."

— Jackson, age 64

"I don't like hospitals. I'm going to try the medicine and other recommendations my doctor made so that I won't have to have surgery. I've started walking a little more every day, and I'm watching what I eat. I know it will be a long road, but it's worth a try."

— Clovis, age 66

3. What matters most to you?

Your personal feelings are just as important as the medical facts. Think about what matters most to you in this decision, and show how you feel about the following statements.

Reasons to have surgery for peripheral arterial disease

Reasons to try lifestyle changes and medicines first

I want to be able to walk without pain now.

I can wait until I see the benefits of my exercise program.

More important
Equally important
More important

I accept the risks of surgery.

I want to avoid surgery.

More important
Equally important
More important

If I can't cure my disease with lifestyle changes, I may as well have surgery.

I want to try lifestyle changes to see if I can improve my condition before I think about surgery.

More important
Equally important
More important

My disease is very bad, and I don't want to lose my leg.

My disease is not that serious yet.

More important
Equally important
More important

I'm committed to quitting smoking so that my surgery has the best chance of success.

I'm not ready to quit smoking.

More important
Equally important
More important

My other important reasons:

My other important reasons:

More important
Equally important
More important

4. Where are you leaning now?

Now that you've thought about the facts and your feelings, you may have a general idea of where you stand on this decision. Show which way you are leaning right now.

Having surgery

Trying lifestyle changes and medicines first

Leaning toward
Undecided
Leaning toward

5. What else do you need to make your decision?

Check the facts

1. Having angioplasty or bypass surgery will allow me to save my leg.

  • True
  • False
  • I'm not sure
That's right. If you have severe peripheral arterial disease, having one of these procedures may save your leg.

2. If I have angioplasty or bypass surgery, I don't need to quit smoking or make other lifestyle changes.

  • True
  • False
  • I'm not sure
You're right. Quitting smoking, exercising, and making other lifestyle changes can help you live longer. Angioplasty and bypass surgery alone will not. You will still need to make these changes for the best long-term results.

3. I can increase my ability to walk without pain if I start an exercise program and make other lifestyle changes.

  • True
  • False
  • I'm not sure
You're right. An exercise program and other lifestyle changes can increase your ability to walk without pain.

Decide what's next

1. Do you understand the options available to you?

2. Are you clear about which benefits and side effects matter most to you?

3. Do you have enough support and advice from others to make a choice?

Certainty

1. How sure do you feel right now about your decision?

Not sure at all
Somewhat sure
Very sure

2. Check what you need to do before you make this decision.

  • I'm ready to take action.
  • I want to discuss the options with others.
  • I want to learn more about my options.

3. Use the following space to list questions, concerns, and next steps.

Credits
ByHealthwise Staff
Primary Medical ReviewerE. Gregory Thompson, MD - Internal Medicine
Specialist Medical ReviewerDavid A. Szalay, MD - Vascular Surgery

References
Citations
  1. Stead LF, et al. (2008). Nicotine replacement therapy for smoking cessation. Cochrane Database of Systematic Reviews (1).

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