Surgical treatment in patients with symptomatic PAD

Dr Sonia Anand is a professor in the Division of Cardiology, associate chair of Equity and Diversity in the Department of Medicine, and director of the Population Genomics Program at McMaster University.

When should a patient with symptoms of peripheral artery disease (PAD) be referred for interventional or surgical treatment?

Sonia Anand, MD, PhD: It is a good question. The usual way a patient presents with PAD is by complaining of leg discomfort with walking, known as intermittent claudication. Usually intermittent claudication can be assessed by a primary care physician, where they measure the blood flow to the leg using the blood pressure cuff on the leg, called the ankle-brachial index. If the ankle-brachial index is much lower than a mild abnormality and/or the patient complains of pain in their legs at night, when sleeping, they have ulceration of their lower leg, or they have blue or black discoloration of their toes, they should be referred on to a vascular interventionist.

That specialist will do additional testing, such as an angiogram of the lower limb, and decide if there is critical limb ischemia. If there is critical limb ischemia, then surgery is definite. If it is on the borderline, together with the patient’s complaints of symptoms, the surgeon will make a decision.