Invasive treatment in PAD

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

Could you comment on invasive treatment options in patients with peripheral artery disease (PAD)?

Sonia Anand, MD, PhD: Once a patient complains of severe limb ischemia and has an angiogram, the surgeon or interventional radiologist would essentially determine if the patient has inflow disease, in which there is a problem getting blood into the legs, or outflow disease, which is carrying the blood that gets into the legs down to the feet. You make that distinction and then match the procedure to the problem.

For inflow disease, a surgery such as aortobifemoral bypass grafting is very effective, especially if the patient is a nonsmoker. Also, iliac stenting is successful in patients who are nonsmokers and have good anatomy.

Patients with outflow disease typically have severe disease below the knee. It is a difficult situation because there is no strong evidence that angioplasty or stenting works well and sometimes the physician has to determine whether to do the femoral-to-popliteal artery bypass and ensure as best they can that the graft does not thrombose and cause a need for a second surgery.

Again, it depends on the type of disease (inflow vs outflow) and on what the anatomy looks like on the angiogram.