Features September 2016 Issue

Revascularization More Effective Than Exercise Alone for PAD

For many patients with peripheral artery disease, receiving a stent will help boost the benefits of regular exercise and reduce symptoms.

Peripheral artery disease (PAD) not only can cause leg pain while walking, it can permanently injure and scar your leg muscles. PAD means the circulation in your legs is reduced due to narrowed arteries. As a result, your muscles and other tissue in your legs don’t get as much oxygenated blood as they should.

A recent study, however, suggests that procedures designed to improve blood flow in those compromised arteries can reduce future muscle scarring. Researchers presenting findings at this year’s American Heart Association conference found that placing stents in the blocked arteries or doing open surgery to create bypass grafts around the blockages can be more effective at helping to prevent scarring from getting worse than exercise without any revascularization procedures.

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To open a blocked leg artery, a catheter is guided to the blockage (top). A tiny balloon is inflated (middle). A flexible stent is left to keep the artery open (bottom).

“For patients with PAD there are many options available for treatment, including revascularization,” says Cleveland Clinic vascular specialist Heather Gornik, MD. “In general, patients are offered a non-interventional approach for claudication (leg pain while walking) first, which for most patients can be highly beneficial. This would include medical therapy and exercise training. Revascularization is a very good option for patients with PAD who are very limited by their leg symptoms.”

She adds that the choice of therapy for PAD should be customized to the individual patient, the severity of their symptoms, and also their anatomy and location and extent of blockages.

Peripheral Artery Disease Treatment Options

A diagnosis of PAD is initially followed by recommendations for healthier lifestyle changes and prescriptions for a variety of medications. You should probably be on a statin and, if necessary, a blood thinner, an antihypertensive and drugs to help control diabetes. You’ll probably be advised to start a walking program. Walking encourages the smaller arteries in the legs to enlarge and keep up a healthy blood supply to your muscles.

“Exercise is a highly effective proven therapy for PAD/claudication, especially supervised exercise training,” Dr. Gornik says.

When Exercise Isn’t Enough

For many PAD patients, surgery or angioplasty is necessary. In angioplasty, a catheter is guided to the site of the blockage and a balloon is inflated to open up room for blood to flow. Sometimes a stent is left in place to keep the artery open. In bypass surgery, a surgeon takes a vein from somewhere else in the leg and attaches it above and below the blockage, providing a new route for blood.

“I think ultimately, it’s the combination of medical therapy, exercise, and revascularization that are used together that may have the greatest benefit for patients who are severely limited with leg symptoms due to PAD,” Dr. Gornik says.

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