Study Analyzes Factors in PAD Patients Who Chose Stenting Over Exercise

May 25, 2016—The Society for Vascular Surgery (SVS) announced findings from a study showing that veterans who could choose between regular exercise or endovascular therapy to improve their leg pain caused by peripheral arterial disease (PAD) were more likely to choose surgery if they had lower socioeconomic status, if they smoked, or if they knew someone who had the same procedure. The study surveyed 102 military veterans affiliated with the Michael E. DeBakey Veterans Affairs Medical Center in Houston, Texas. 

The study was conducted by Principal Investigator Neal Barshes, MD, Panos Kougias, MD, and epidemiology researcher Sherene E. Sharath, MPH. The investigators will present their findings at the SVS 2016 Vascular Annual Meeting to be held June 8–11 in National Harbor, Maryland. Ms. Sharath is a doctoral candidate producing a dissertation on public health and epidemiology, with a focus on PAD pain.

In the SVS announcement, Dr. Barshes commented, “We don’t know exactly why there is a correlation with smoking. I suspect that people who currently smoke are less likely to initiate their own changes in health behaviors. They may have a more passive approach to their health. Those who have successfully quit might be more willing to initiate an exercise program.”

According to SVS, the patients were mostly male, age 65 years or older, and had leg pain caused by PAD. Ms. Sharath advised that the investigators were interested in how perceptions and beliefs related to interventions. 

Ms. Sharath stated in the press release, “We thought that economic disadvantage might just be a proxy for lack of adequate exercise facilities or sidewalks. Previously, we found associations between difficulty walking in neighborhoods due to traffic and safety issues, lack of sidewalks, and the severity of pain. This environmental disadvantage may encourage people to seek the ‘quick-fix’ of stenting rather than the relatively slower results that can be expected from exercise.”

Additionally, the investigators found that patients who knew someone who had undergone the procedure were more likely to believe that surgery was best, despite a surgeon’s advice that exercise worked just as well.

Ms. Sharath advised, “The reasoning behind this belief is something that we would have to measure and examine in the future. We want to get a holistic view of where patients are coming from. Every patient has perceptions and ideas that influence how they respond to treatment recommendations. There are other factors that affect their decision and we should take that into account.”

Dr. Barshes noted that the lack of interest in going for regular walks was interesting, given that all the participants were former military. He commented, “At one point in their life they were pretty physically fit due to military service.”

Regarding physicians trying to influence the patient’s decision, Ms. Sharath commented, “I wouldn’t feel comfortable trying to sway them using what we know at the moment. We want to make sure we understand the entire picture before we recommend one or the other. We do believe these factors influence adherence to exercise.”