Study Finds Lifestyle Changes Preferable Over Interventions in Treating Asymptomatic PAD

October 21, 2009—The Society of Interventional Radiology announced that a study of more than 900 patients by Aoife N. Keeling, MD, et al published in the Journal of Vascular and Interventional Radiology concluded that there is not enough evidence yet to advocate endovascular treatment in patients who have asymptomatic peripheral artery disease (PAD) in the legs (2009;20:1133-1140).

Although PAD can progress and worsen over time, the investigators stated that modifying the risk of PAD with healthy lifestyle changes remains vital to a person's health.

"In the early stages of PAD, many patients will have no symptoms at all and often will go undiagnosed," commented Dr. Keeling. She indicated that the prevalence or frequency of asymptomatic PAD is likely underestimated; however, researchers studied whether minimally invasive treatments such as angioplasty and/or stenting should be offered to asymptomatic PAD patients.

"Although this study is useful in examining the possibility of treating PAD earlier, additional research into the factors that cause PAD progression and the rate of progression—along with methods to slow the disease—need to be conducted," said Dr. Keeling. "Prevention of PAD progression is vital and can be achieved with risk factor modification, for example, if individuals stop smoking, watch their diets, lower their cholesterol, and have their blood pressure monitored."

In the study, 918 patients had leg angiograms. Of these, 122 patients (54% male, average age 70 years) had an arterial narrowing (50%) or blockage without any corresponding leg symptoms. These patients were followed over a maximum of 9 years to determine if they developed any symptoms and to see if they required any treatment for their PAD in the form of angioplasty, stenting, surgical bypass, or amputation. One-third of the 122 patients developed symptoms of pain or ulceration, and almost half of these patients then required treatment.

Overall, only 13.9% of the initial group required treatment; so even though PAD progressed over time, the investigators did not believe they had enough evidence to advocate early minimally invasive treatment of PAD in patients who had no initial symptoms. The fact that most of the 122 patients remained asymptomatic may be related to the intense risk factor modification they underwent or other factors as yet unidentified, stated Dr. Keeling.

"We know that many patients have blockages in their leg arteries but may not develop symptoms. We don't know yet what causes symptoms to develop in some but not in others. We are continuing our research in this area," stated Dr. Keeling.