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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?
1Get the | 2Compare | 3Your | 4Your | 5Quiz | 6Your Summary |
Get the facts
Your options
- Have angioplasty or bypass surgery.
- Try lifestyle changes, medicines, and exercise to reduce leg pain.
This decision aid is for people who have symptoms from peripheral arterial disease, such as leg pain when they exercise. This decision aid is not for people who need treatment right away for severely limited blood flow to a leg or foot.
Key points to remember
- Your doctor may advise you to try lifestyle changes, medicine, or exercise before you think about angioplasty or bypass surgery. Making these changes or taking medicine 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.
- Angioplasty or bypass may help with more severe symptoms. You may want to have one of these procedures if pain or other symptoms keep you from doing your daily activities.
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. 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.
How is peripheral arterial disease treated?
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.
What kinds of procedures are done for peripheral arterial disease?
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.
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:
- 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.
Why might your doctor recommend having a procedure?
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.
Compare your options
Compare
What is usually involved? |
| |
|---|---|---|
What are the benefits? |
| |
What are the risks and side effects? |
|
- 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 may spend 1 to 4 days in bed after surgery. You may be in the hospital for 3 to 7 days.
- You will still need to make lifestyle changes and take medicines. Lifestyle changes include not smoking, eating healthy, and exercising.
- Either of these procedures will restore blood flow and relieve leg pain right away.
- Angioplasty or bypass surgery can increase your ability to walk.
-
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.
- You make healthy lifestyle changes. These include not smoking, eating healthy, and exercising.
- You take medicine as prescribed by your doctor.
- You try an exercise program designed especially for people with PAD.
- 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
- Medicine may help relieve symptoms.
- Exercise or medicine might not relieve your symptoms.
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 took up walking after recently retiring, but I had to stop because of the pain. My doctor says I can have angioplasty, a procedure that will improve blood flow in my legs. So I think I'll go ahead with it so that I can keep doing the things I enjoy.
Julio, age 68
I've known for a long time that I need to quit smoking and take better care of myself. My doctor said that if the disease in my leg arteries gets worse, I may need a surgery. That's enough to make me want to change. I'm going to try quitting smoking again.
Nancy, age 55
My doctor says that the disease in my blood vessels is really bad. I tried a walking program, but it didn't help my pain. So 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
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 accept the risks of surgery.
I want to avoid surgery.
I have a lot of pain, so I want to try surgery.
I want to try exercise or medicine before I think about surgery.
I'm committed to making healthy lifestyle changes so that my surgery has the best chance of success.
I'm not ready to change my lifestyle.
My other important reasons:
My other important reasons:
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
What else do you need to make your decision?
Check the facts
Decide what's next
Certainty
1. How sure do you feel right now about your decision?
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
| Author | Healthwise Staff |
|---|---|
| Primary Medical Reviewer | Rakesh K. Pai, MD, FACC - Cardiology, Electrophysiology |
| Primary Medical Reviewer | E. Gregory Thompson, MD - Internal Medicine |
| Primary Medical Reviewer | Martin J. Gabica, MD - Family Medicine |
| Primary Medical Reviewer | Adam Husney, MD - Family Medicine |
| Specialist Medical Reviewer | David A. Szalay, MD - Vascular Surgery |
- Chung J, Dodson T (2011). Surgical treatment of carotid and peripheral vascular disease. In V Fuster et al., eds., Hurst's The Heart, 13th ed., vol. 2, pp. 2347-2354. New York: McGraw-Hill.
- Conte MS, et al. (2015). Society for Vascular Surgery practice guidelines for atherosclerotic occlusive disease of the lower extremities: Management of asymptomatic disease and claudication. Journal of Vascular Surgery, 61(3S): 2S-41S. DOI: 10.1016/j.jvs.2014.12.009. Accessed November 25, 2016.
- Fowkes F, Leng GC (2008). Bypass surgery for chronic lower limb ischaemia. Cochrane Database of Systematic Reviews (2).
- Gerhard-Herman MD, et al. (2016). 2016 AHA/ACC guideline on the management of patients with lower extremity peripheral artery disease. Circulation, published online November 13, 2016. DOI: 10.1161/CIR.0000000000000471. Accessed November 25, 2016.
- Kinlay S, Bhatt DL (2015). Treatment of noncoronary obstructive vascular disease. In DL Mann et al., eds., Braunwald's Heart Disease: A Textbook of Cardiovascular Medicine, 10th ed., vol. 2, pp. 1347-1364. Philadelphia: Saunders.
Peripheral Arterial Disease: Should I Have Surgery?
- Get the facts
- Compare your options
- What matters most to you?
- Where are you leaning now?
- 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.
This decision aid is for people who have symptoms from peripheral arterial disease, such as leg pain when they exercise. This decision aid is not for people who need treatment right away for severely limited blood flow to a leg or foot.
Key points to remember
- Your doctor may advise you to try lifestyle changes, medicine, or exercise before you think about angioplasty or bypass surgery. Making these changes or taking medicine 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.
- Angioplasty or bypass may help with more severe symptoms. You may want to have one of these procedures if pain or other symptoms keep you from doing your daily activities.
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. 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.
How is peripheral arterial disease treated?
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.
What kinds of procedures are done for peripheral arterial disease?
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.
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:
- 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.
Why might your doctor recommend having a procedure?
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.
2. Compare your options
| Have angioplasty or bypass surgery | Try lifestyle changes, exercise, and medicine | |
|---|---|---|
| What is usually involved? |
|
|
| What are the benefits? |
|
|
| What are the risks and side effects? |
|
|
Personal stories
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 took up walking after recently retiring, but I had to stop because of the pain. My doctor says I can have angioplasty, a procedure that will improve blood flow in my legs. So I think I'll go ahead with it so that I can keep doing the things I enjoy."
— Julio, age 68
"I've known for a long time that I need to quit smoking and take better care of myself. My doctor said that if the disease in my leg arteries gets worse, I may need a surgery. That's enough to make me want to change. I'm going to try quitting smoking again."
— Nancy, age 55
"My doctor says that the disease in my blood vessels is really bad. I tried a walking program, but it didn't help my pain. So 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 accept the risks of surgery.
I want to avoid surgery.
I have a lot of pain, so I want to try surgery.
I want to try exercise or medicine before I think about surgery.
I'm committed to making healthy lifestyle changes so that my surgery has the best chance of success.
I'm not ready to change my lifestyle.
My other important reasons:
My other important reasons:
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
5. What else do you need to make your decision?
Check the facts
1. Having angioplasty or bypass surgery may help me walk without pain.
- True
- False
- I'm not sure
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
3. I may be able to walk farther without pain if I start an exercise program and make other lifestyle changes.
- True
- False
- I'm not sure
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?
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.
| By | Healthwise Staff |
|---|---|
| Primary Medical Reviewer | Rakesh K. Pai, MD, FACC - Cardiology, Electrophysiology |
| Primary Medical Reviewer | E. Gregory Thompson, MD - Internal Medicine |
| Primary Medical Reviewer | Martin J. Gabica, MD - Family Medicine |
| Primary Medical Reviewer | Adam Husney, MD - Family Medicine |
| Specialist Medical Reviewer | David A. Szalay, MD - Vascular Surgery |
- Chung J, Dodson T (2011). Surgical treatment of carotid and peripheral vascular disease. In V Fuster et al., eds., Hurst's The Heart, 13th ed., vol. 2, pp. 2347-2354. New York: McGraw-Hill.
- Conte MS, et al. (2015). Society for Vascular Surgery practice guidelines for atherosclerotic occlusive disease of the lower extremities: Management of asymptomatic disease and claudication. Journal of Vascular Surgery, 61(3S): 2S-41S. DOI: 10.1016/j.jvs.2014.12.009. Accessed November 25, 2016.
- Fowkes F, Leng GC (2008). Bypass surgery for chronic lower limb ischaemia. Cochrane Database of Systematic Reviews (2).
- Gerhard-Herman MD, et al. (2016). 2016 AHA/ACC guideline on the management of patients with lower extremity peripheral artery disease. Circulation, published online November 13, 2016. DOI: 10.1161/CIR.0000000000000471. Accessed November 25, 2016.
- Kinlay S, Bhatt DL (2015). Treatment of noncoronary obstructive vascular disease. In DL Mann et al., eds., Braunwald's Heart Disease: A Textbook of Cardiovascular Medicine, 10th ed., vol. 2, pp. 1347-1364. Philadelphia: Saunders.
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Current as of: October 5, 2017
