Restoring Blood Flow Reduces Pain in Patients with Peripheral Artery Disease
/By Pat Anson, PNN Editor
Restoring blood flow to the legs significantly reduces pain and improves quality of life for people with peripheral artery disease (PAD), according to new research presented this week at the American Heart Association’s Scientific Sessions in Chicago.
Over 200 million people worldwide suffer from PAD -- a narrowing of peripheral arteries throughout the body that can cause severe leg pain, cramping and fatigue after a short walk or even just climbing a flight of stairs. In one out of ten people with PAD, the lack of blood flow can lead to chronic limb-threatening ischemia (CLTI), where people experience pain even when resting. Left untreated, tissue damage in the leg may result in amputation.
To restore blood flow, a common treatment for PAD is leg bypass surgery, in which a passage around the blocked arteries is created by using another vein from the leg of a patient. A less invasive approach is angioplasty, in which a balloon-tipped catheter is inserted into the blocked artery to widen it. A stent is then often placed to keep the artery open.
Few studies have compared the effectiveness of bypass surgery to angioplasty and stenting, which are known as “endovascular” procedures.
“The large body of high-quality evidence that guides treatment of heart disease and stroke does not exist for PAD, and until now, there has been almost no data to inform the care of CLTI patients,” says lead author Matthew Menard, MD, an associate professor of surgery at Harvard Medical School, and co-director of endovascular surgery at Brigham and Women’s Hospital.
In the first large-scale randomized controlled study of its kind, Menard and his colleagues enrolled 1,830 people with severe PAD at 150 centers in the U.S., Canada, Italy, Finland and New Zealand. Participants were surveyed at the beginning of the study about their quality of life and at several follow-up visits for 4 years after their surgery or procedure. The surveys asked about pain, PAD symptoms and severity, physical activity and mental health.
Pain levels were high and quality-of-life scores were low at the beginning of the study, reflecting the poor health and well-being of many patients with CLTI. But after surgery or an endovascular procedure, pain scores decreased significantly and quality-of-life scores improved for all participants.
“Improvement in health-related quality-of-life measures regardless of the type of procedure is very encouraging and highlights the importance of timely restoration of blood flow to the leg and foot,” said Menard.
Menard noted there were some differences initially between the two study groups favoring endovascular procedures, possibly reflecting the longer recovery time for a surgical bypass. But the differences were not “clinically meaningful” and leveled out over time.
“The quality-of-life data are a nice complement to the clinical results and suggest that both revascularization strategies may effectively improve a patient’s quality of life. So, while there is still much work to be done, and quality-of-life measures have not always been the focus in past PAD research, this is an important step forward,” he said.
PAD patients who don’t have bypass surgery or endovascular procedures may want to continue walking despite the pain and discomfort, according to a recent study. Researchers at Northwestern University’s Feinberg School of Medicine found that elderly PAD patients who exercised 5 days a week walked at a faster pace and performed better on physical performance tests than non-walkers.
Between 8 and 10 million people in the United States have PAD. The condition disproportionately affects African-Americans, Native Americans and those with low socioeconomic status.
