Plus, what to expect after the procedure.
Peripheral artery disease, or PAD, occurs when cholesterol deposits, known as plaques, cause a narrowing of the arteries that supply blood flow to your extremities, kidneys, intestines or brain. Sometimes lower-extremity PAD requires surgery to restore quality of life if the condition is impacting mobility or a blockage is severe. If you’re experiencing complications from PAD, you might be wondering what surgery entails and what to expect post-op.
“About 10% of the population over 70 will have lower-extremity PAD,” said Dr. Daniel Clair, a vascular surgeon at the Vanderbilt Heart and Vascular Institute. “Of that 10%, the majority won’t have symptoms. But if they have tissue loss or pain at rest, those patients need to have an intervention.”
When PAD surgery is needed
Of patients who have PAD, about 20% will have what’s called claudication, Dr. Clair explained. Claudication is inadequate blood flow to deliver oxygen when your legs are working.
“If they have claudication, where they’re having trouble walking,” Dr. Clair said, “it really limits what they’re able to do. For example, if it’s so severe that they can’t do their grocery shopping or get their mail and get back to their house, then they may need surgery.”
About 2% to 5% of patients with PAD will have an advanced form of the disease that may cause pain at rest, as well as during movement, or even tissue loss from a wound that won’t heal. In those cases, surgery is also required.
Surgical interventions for PAD
Standard clinical interventions for PAD include angioplasty, stenting, endarterectomy, bypass grafting or a combination of these procedures.
“In angioplasty,” Dr. Clair explained, “we use a balloon to crush the plaque or crush the atherosclerosis and open up a pathway for blood flow.”
However, sometimes in addition to angioplasty, a stent is required. “The stent is a metal mesh framework that holds the disease back and holds the tunnel for blood flow open,” he added.
Endarterectomy is a procedure that cleans out the plaque in a segment of artery to restore blood flow. “Sometimes endarterectomy can be combined with either angioplasty or stenting or both,” Dr. Clair said.
Bypass grafting, another type of procedure, bypasses a blockage. “We use a piece of tubing, either a patient’s vein or prosthetic or plastic material,” he explained.
A limited number of locations around the world, including Vanderbilt, also perform an intervention called deep vein arterialization. About 15% to 20% of patients who have a non-healing wound or pain at rest will have advanced disease that will prevent bypass grafting. “In those patients,” Dr. Clair said, “we have begun diverting the blood flow from the arteries into one of the veins in the foot.”
Recovery after PAD intervention
Angioplasty or stenting for patients with claudication is typically performed as an outpatient procedure. “Patients can expect improved walking without limitations within a couple days,” Dr. Clair said.
Patients who receive an endarterectomy will spend one night in the hospital. It may be one to two weeks before they notice improved walking and blood flow.
Patients who require bypass grafting will spend three days to one week in the hospital. After discharge, they will need several more weeks of recovery before experiencing improvements.
Some patients with advanced disease who have foot wounds that need to heal may require longer recovery times, up to a couple months.
Quality of life after PAD surgery
If PAD causes you pain when you walk, surgery reduces that pain and helps you to regain your mobility. “And if you have a wound on your foot that’s not healing or that’s turned dark, that’s a problem,” Dr. Clair explained. “Surgery not only improves quality of life, but it also offers you the chance to to retain your foot much better than if we don’t get blood flow back to the foot.”
No matter the intervention, Dr. Clair said, he includes exercise therapy as part of PAD treatment. Patients can undergo a supervised exercise program at Vanderbilt when necessary. “Exercise is beneficial for overall health and for increasing patients’ capacity to do activities,” he added. In some cases, exercise may even help patients avoid a procedure, and in other cases where a procedure is required, physical activity helps aid recovery.