Treating blocked leg arteries: When you need a procedure—and when you don’t

PAD leg arteries

The arteries in your legs and feet can get blocked, just like the arteries in your heart. When this happens, less blood flows to your legs. This is called peripheral artery disease (PAD).

Occasionally, if your leg arteries are badly blocked, you may develop foot pain while resting or a sore that won’t heal. In this case, you need a procedure to remove the blockages. But usually, people with PAD do not need a procedure. Here’s why:

A procedure only helps for severe symptoms.

If PAD causes severe leg pain when walking, you may stop doing that and other activities. Surgery to bypass the blockage can relieve these symptoms. So can another procedure known as angioplasty.

Most people do not have symptoms.

For most people, PAD does not cause symptoms. Those who do develop symptoms might get a heavy, tired feeling or cramping in the legs while walking that only goes away when they stop walking. Taking medicine, stopping smoking and walking more can actually reduce your symptoms and help keep PAD from getting worse.

Some doctors mistakenly recommend having surgery or angioplasty even if you do not have symptoms, or have minimal symptoms. However, this does not make people with PAD feel better or prevent future leg problems. Most people with PAD never develop problems that need surgery or angioplasty. This is because they do not have severe symptoms or because medicine and exercise work well enough to treat the pain and allow a normal lifestyle.

There are safe and simple ways to keep PAD from getting worse.

To control PAD, you should stop smoking and walk every day. And you should also work with your doctor to control other risk factors, such as diabetes, high blood pressure and high cholesterol.

Even if you have symptoms, you may be better off not having a procedure. Studies show that walking every day can relieve symptoms just as well as angioplasty, in some cases.

Surgery and angioplasty have risks and it takes time to get better.

Bypass surgery on your legs has all the dangers of surgery. It takes two to three weeks for the wound to heal. Risks include infection, bleeding from the wound, and complications from anesthesia, such as trouble breathing or pneumonia.

Angioplasty is not as hard on your body as surgery, and the recovery is faster. But stents may not provide a lasting treatment and the original symptoms can come back within a year.

Both procedures can, in rare cases, cause a partly blocked artery to close up completely. Then you may need an emergency procedure.

When do you need a procedure for PAD?

You and your doctor should consider surgery or angioplasty if:

  • Your symptoms are severe enough to limit your lifestyle or your ability to work.
  • Simpler treatments, such as exercise and medicine, have not helped.

See your doctor right away to be evaluated for a procedure if you have any of these signs:

  • Foot pain when you’re resting, especially at night.
  • Sores on your toes or feet that do not heal.
  • A toe that looks blue or black and may hurt.

How to manage PAD:

Taking these steps can help keep PAD from getting worse. They can also reduce your risk of having a heart attack or stroke.

Don’t smoke. Smoking even one or two cigarettes a day can keep treatment for PAD from working. If you smoke, talk to your doctor about nicotine replacement therapy and anti-smoking programs. The antidepressant bupropion (Zyban and generic) can help people quit. The drug varenicline (Champix) also works well when combined with a stop smoking program.

Exercise regularly. Walking, followed by periods of rest, can help reduce symptoms and extend the distance you’re able to walk. Your doctor should be able to help you plan a routine.
Eat healthy foods. Extra cholesterol and fat can cause blocked arteries. Avoid saturated fat, trans fat and cholesterol. Limit foods with added sugar such as desserts and sodas. Eat vegetables, fruits, low-fat dairy products and whole grains.

Take your medicines. You will need to take aspirin and/or clopidogrel (Plavix and generic) to prevent blood clots. And you may need medicines for other risk factors, such as high blood pressure, high cholesterol or diabetes.

Take care of your feet. Wear comfortable shoes that don’t rub. Wash your feet daily with warm water and mild soap and use moisturizer cream on your legs and feet. Check for cuts, sores, blisters or other injuries. Call your doctor if you notice a problem. If you have diabetes, take extra care of your feet.