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Peripheral Arterial Disease: Should I Have a Procedure or 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 a Procedure or Surgery?
1Get the | 2Compare | 3Your | 4Your | 5Quiz | 6Your Summary |
Get the facts
Your options
- Have angioplasty or surgery.
- Try medicine or a specialized exercise program 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 for severely limited blood flow to a leg or foot.
Key points to remember
- Your doctor may advise you to try medicine or a specialized exercise program before you think about angioplasty or surgery. Medicine or this exercise program might help you walk without pain. And they don't have the risks of surgery or angioplasty.
- Angioplasty or surgery 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.
- Medicine and a heart-healthy lifestyle are also part of the treatment for peripheral arterial disease. Medicine and a healthy lifestyle can help slow the progress of the disease and lower your risk of a heart attack and stroke.
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 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.
How is peripheral arterial disease treated?
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.
What kinds of procedures or surgeries are done for peripheral arterial disease?
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.
What are the risks of these procedures?
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.
Why might your doctor recommend having a procedure?
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.
Compare your options
Compare
What is usually involved? | | |
|---|---|---|
What are the benefits? | | |
What are the risks and side effects? | |
- With angioplasty, you may go home the same day. Or you may spend the night in the hospital. For 1 or 2 days after the procedure, you will need to take it easy at home.
- Depending on the type of surgery, you may spend 2 days to several days in the hospital. You may need to take it easy for a few weeks at home. It may take up to 2 to 3 months to fully recover.
- You will still need to have a heart-healthy lifestyle and take medicines. This lifestyle includes not smoking, eating healthy, and being active.
- Either of these procedures can restore blood flow and relieve leg pain right away.
- Angioplasty or surgery can increase your ability to walk.
- Risks of 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 take medicine that may relieve symptoms as prescribed by your doctor.
- You try an exercise program designed especially for people with PAD.
- You will still need to have a heart-healthy lifestyle and take medicines. This lifestyle includes not smoking, eating healthy, and being active.
- A specialized exercise program may help relieve symptoms.
- Medicine may help relieve symptoms.
- Exercise or medicine might not relieve your symptoms.
- Medicine side effects include headache, diarrhea, and heart palpitations.
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
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. I hope it works so I can avoid surgery. My doctor says I can try an exercise program too.
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 an exercise program or medicine 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.
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 an exercise program and medicine 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 | Ignite Healthwise, LLC Staff |
|---|---|
| Clinical Review Board | Clinical Review Board All Healthwise education is reviewed by a team that includes physicians, nurses, advanced practitioners, registered dieticians, and other healthcare professionals. |
Peripheral Arterial Disease: Should I Have a Procedure or 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 surgery.
- Try medicine or a specialized exercise program 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 for severely limited blood flow to a leg or foot.
Key points to remember
- Your doctor may advise you to try medicine or a specialized exercise program before you think about angioplasty or surgery. Medicine or this exercise program might help you walk without pain. And they don't have the risks of surgery or angioplasty.
- Angioplasty or surgery 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.
- Medicine and a heart-healthy lifestyle are also part of the treatment for peripheral arterial disease. Medicine and a healthy lifestyle can help slow the progress of the disease and lower your risk of a heart attack and stroke.
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 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.
How is peripheral arterial disease treated?
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.1
- A medicine, called cilostazol, can relieve pain that comes on with activity.
What kinds of procedures or surgeries are done for peripheral arterial disease?
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.
What are the risks of these procedures?
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.
Why might your doctor recommend having a procedure?
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.
2. Compare your options
| Have angioplasty or surgery | Try exercise or 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
"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. I hope it works so I can avoid surgery. My doctor says I can try an exercise program too."
— 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 an exercise program or medicine 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.
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 an exercise program and medicine first
5. What else do you need to make your decision?
Check the facts
1. Having angioplasty or surgery may help me walk without pain.
- True
- False
- I'm not sure
2. If I have angioplasty or surgery, I don't need to have a heart-healthy lifestyle or take medicine.
- True
- False
- I'm not sure
3. I may be able to walk farther without pain if I start a specialized exercise program or take medicine.
- 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 | Ignite Healthwise, LLC Staff |
|---|---|
| Clinical Review Board | Clinical Review Board All Healthwise education is reviewed by a team that includes physicians, nurses, advanced practitioners, registered dieticians, and other healthcare professionals. |
Note: The "printer friendly" document will not contain all the information available in the online document some Information (e.g. cross-references to other topics, definitions or medical illustrations) is only available in the online version.
Current as of: July 31, 2024
Author: Ignite Healthwise, LLC Staff
Clinical Review Board
All Healthwise education is reviewed by a team that includes physicians, nurses, advanced practitioners, registered dieticians, and other healthcare professionals.
This information does not replace the advice of a doctor. Ignite Healthwise, LLC disclaims any warranty or liability for your use of this information. Your use of this information means that you agree to the Terms of Use and Privacy Policy. Learn how we develop our content.
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