Peripheral Artery Disease (PAD) doesn’t sound like such a big deal — until you hear that every year, 100,000 Americans must have a leg amputated because of it. That doesn’t sound so “peripheral” to me… it’s something I’d do nearly anything to avoid. Fortunately, doctors have now found a treatment that circumvents that horrible outcome for the vast majority of patients who do end up with PAD.

What Is Peripheral Artery Disease?

Since many are not fully up-to-date on the dangers of PAD, let’s start with a quick description of the problem. Characterized by chronic leg pain, PAD affects some 12% to 20% of people age 65 and older, according to the American Heart Association. It’s a circulatory issue caused by narrowing of the arteries into the legs. Blood flow is drastically reduced, sometimes blocked — if this is left untreated, it can lead to ischemic pain (felt while at rest) in the leg… wounds around the toes and feet… gangrene… and possibly the need for amputation of the lower leg. This most severe form of PAD is referred to as critical limb ischemia (CLI).

Until now, the gold standard treatment for CLI has been bypass surgery, just like what’s done in cardiac arteries. But many PAD patients have other medical conditions that make it dangerous for them to undergo major surgery like this. Some are successfully treated with medications, others with angioplasty (using a balloon to open the narrowed artery), but for many patients these measures are not enough. Now there’s new hope in the form of drug-eluting stents that both prop open the artery and release medication to help keep it open. In a new study involving 53 PAD patients, doctors at Mount Sinai Medical Center in New York City achieved 100% success using drug-eluting stents to improve blood flow to limbs of patients with CLI… and after 17 months, 90% still had not required amputation. However, it is important to note that while stenting is a minimally invasive procedure, it does carry some risk (usually in the form of bleeding complications) and also, stents don’t last forever, so replacement and possibly bypass surgery may someday be necessary.

The Long View…

Interventional radiologist Robert A. Lookstein, MD, associate professor of radiology and surgery at Mount Sinai Medical Center in New York City, was the lead author of the study. He told me that drug-eluting stents offer a “robust technology for restoring circulation when angioplasty has failed. The fact that we can use a minimally invasive technology to help patients avoid amputation is truly remarkable.” Although there is no long-term data yet, more than 80% of the implanted stents held up over the first year — far better than plain balloon angioplasty, which previous data shows as lasting as long as one year in only 30% of the cases.

Of course, it is better yet to avoid the problem in the first place. Exercise and a healthy diet — as well as quitting if you smoke — not only work immediately to slow progression of PAD, but in fact can help prevent it from occurring at all. If you do develop PAD, Dr. Lookstein says that early diagnosis and lifestyle modification are, without question, “the best ways to stabilize it and keep it from progressing.” Anyone over 60 — or over 50 if you smoke, have diabetes or high blood pressure or are obese — should pay special attention to pains that develop in the lower legs. Have your physician examine the pulses in your legs, possibly order a vascular ultrasound and refer you to a vascular specialist, if necessary, who will determine the extent of the problem and discuss treatment options.