As CEO of the Global PAD Association, I’m constantly seeking insights from leading experts to help our community better understand and manage peripheral artery disease. Recently, I had the privilege of sitting down with Dr. Vincent Rowe, Chief of Vascular and Endovascular Surgery at UCLA, for our “What’s Up Doc?” series. His perspectives were so valuable that I wanted to share them more widely for those who prefer reading to watching videos.
Early Diagnosis: A Critical Missing Piece
One of the first topics we discussed was something I hear about constantly from our patient community—the devastating impact of delayed diagnosis. Dr. Rowe emphasized that early detection is crucial because it allows patients to address their specific risk factors before the disease progresses.
“If I make a diagnosis and tell someone they have arterial disease, I can tell them what led to it in their particular case,” he explained during our conversation. “If it’s smoking, I can recommend they stop. If it’s diabetes, they can take steps to improve their metrics.”
What struck me was his observation about a critical gap in our healthcare system. Unlike mammograms or colonoscopies, there’s no standardized screening protocol for PAD. Dr. Rowe mentioned legislation that has been “swirling around in Washington for probably a decade” but hasn’t been passed. This lack of mandated screening means so many people in our community suffer needlessly because their PAD wasn’t caught early.
Understanding PAD & Treatment Options:
In this interview, we don’t talk about all aspects of PAD and treatment options. We talk about the aspects of interest to the viewers who attended this session. Below, Dr. Rowe addresses aorto bifemoral bypass surgery, PAD in the arms, the importance of getting to the root source of PAD, as well as diabetes and PAD. If you want to learn more about PAD and its treatment options, subscribe to our Youtube Channel: https:/Youtube.com/@TheWayToMyHeart. You can also go to PADhelp.org or call the Global PAD Association’s Leg Saver Hotline at 1-833-PAD-LEGS.
When Is Bypass Surgery Necessary?
One of our viewers, Tracy, asked a question I hear frequently: When is an aorto-bifemoral bypass necessary, and shouldn’t doctors try less invasive approaches first?
Dr. Rowe’s answer was reassuring. He explained that most vascular specialists now attempt to open blocked vessels with balloons and stents before considering bypass surgery. “But if the disease is so extensive that it heads up higher, like all the way up above the belly button in the aorta, then we’re going to most likely recommend a bypass.”
While he noted that bypass remains the “gold standard” against which all treatments are measured, it’s now reserved for specific cases where minimally invasive approaches won’t work—something I wish more patients understood before they fear the worst when PAD is diagnosed.
Getting to the Root Cause
A question that truly resonated with me came from a member who asked whether doctors should determine exactly what’s clogging arteries before treatment. This is something we advocate strongly for at the Global PAD Association!
Dr. Rowe strongly agreed: “You do need to know exactly what is the cause.” He shared a compelling example of a patient with a blockage behind the knee but otherwise clean vessels, which turned out to be caused by clot from a heart condition. This patient needed completely different treatment than someone with widespread plaque from smoking or diabetes.
This underscores why we always encourage our community to seek a second opinion before major procedures. Understanding the true cause of your blockages can completely change your treatment path.
PAD in the Upper Extremities
Cindy asked about PAD affecting the arms, which is something we don’t hear about as often. Dr. Rowe explained that while rare, it definitely can occur.
“We see it a lot for people with hand complaints and most of the time it’s not PAD in the arms, but it can occur,” he noted. “The hard part is it can occur all the way from in the forearms, in the upper arm, around the chest area.”
His recommendation was to start with an ultrasound of the vessels in the shoulder and neck region. If issues are found, a CT scan might be the next step. He mentioned that plaque can form in the subclavian vessel or other vessels in the chest and shoulder area, similar to how it forms in the legs.
Diabetes and PAD: What Happens Inside Your Vessels
I was particularly fascinated by Dr. Rowe’s explanation of how diabetes affects blood vessels. When asked what blood actually looks like in poorly controlled diabetes, his answer surprised me.
“The blood actually looks the same. The big risk with someone whose A1C is out of control is how they’re going to heal.” He explained that uncontrolled diabetes increases infection risk and impairs wound healing.
What I found most illuminating was his description of the vessels themselves: “As opposed to having a vessel that’s kind of soft like a straw, now you have a vessel that’s almost like a pipe.” This vessel hardening makes all interventions more challenging—a powerful visual that helps explain why controlling diabetes is so crucial for PAD patients.
Walking as Medicine: Dr. Rowe’s Motivational Speech
Douglas, who heads our PAD Warrior Task Force of Patients, always asks our doctor guests for their best motivational speech for walking as medicine. Dr. Rowe’s response was beautifully straightforward:
“This is the treatment that you need. It’s free. You can do it whenever you want to. And you can do as much as you want to. But it’s really up to you. You are now the one in charge. We’re not asking you to take a medication, take an injection. All we’re asking you to do is do something that you’ve been doing since you were two years old—to get up and go walk.”
He then shared a success story about a patient who combined walking with “grounding” (walking barefoot in the sand or grass), which not only improved circulation to her legs but also reduced blockage in her carotid arteries. As he put it, “It’s not only helped the circulation to her legs, it’s also helped the circulation to her carotid artery. She had blockage there, and she overall just feels much better.”
What I love about his motivational approach is that it puts the patient in control of their health journey: “If you’re willing to invest that amount of work, which doesn’t seem like a lot to me, but if you can do that, I’m willing to invest and take care of you.” This partnership approach is exactly what creates successful outcomes in PAD treatment.
Building Collateral Vessels: The Reindeer Story
One fascinating moment came when Natalie asked if building collateral vessels would improve her ABI (ankle-brachial index) measurements. Dr. Rowe not only confirmed that it could, but shared a remarkable story about how collateral vessels were first discovered:
“That was discovered probably 70, 80 years ago by, I think it was Dr. Hunter. He was doing some research on reindeers and he went into the neck area and clipped off the vessel that was the main one to the antlers. And then he saw that they stopped growing and they weren’t going as much, everything stopped.”
But what happened next was the true revelation: “Then he waited like six months later and he saw them start growing again. So then he went back into the neck to look to see what happened, and he saw these vessels going around the artery that he had clipped off. It just took a while for those collaterals to form.”
This is exactly why we so strongly advocate for walking programs at the Global PAD Association. As Dr. Rowe explained: “Your body is going to try to build those collaterals naturally, but then you’re going to help build them even more by doing some walking. You’re going to help accelerate that process and make those vessels even bigger so that you may not even need some type of intervention.”
I’ve seen this work with countless patients in our network who’ve avoided procedures through dedicated walking programs. It’s living proof that our bodies have remarkable healing capabilities when we give them the right conditions.
Managing PAD in Challenging Circumstances:
PAD and Cancer
One of the most heartbreaking questions came from Melody about her father who has both terminal cancer and critical limb ischemia. Doctors in the UK had refused to treat his PAD since he was marked palliative, even though his legs were causing tremendous pain and deteriorating rapidly.
Dr. Rowe acknowledged these situations are “very complicated for all parties.” His approach involves first assessing where the cancer is in its progression and how the patient is responding to treatments. Then, crucially, talking to the patient about their priorities.
“We usually try to keep them out of pain and keep them functional as the cancer treatments continue or as the cancer advances,” he explained. “If you can provide treatment to improve circulation that won’t interrupt or interfere with cancer care, we definitely try to do both at the same time.”
This patient-centered approach is exactly what we advocate for at the Global PAD Association – treating the whole person, not just a disease.
Coping with Summer Heat
With hot weather affecting so many in our community, Tara asked about coping strategies for PAD patients during summer. Dr. Rowe emphasized hydration as critical:
“Getting very dehydrated, your blood pressure could go low. Maybe that little blockage can turn all the way to a complete occlusion in your legs if you get severely dehydrated.”
He offered practical solutions I know our community will appreciate: walking in air-conditioned spaces like malls or Costco, exercising early in the morning or late evening, or even considering a reduced gym membership for safe, climate-controlled exercise. These are exactly the kind of actionable tips that make a real difference in daily life with PAD.
Supplements for Vascular Health
When I asked about supplements for PAD—one of our top five questions at the Global PAD Association—Dr. Rowe first emphasized the importance of aspirin. Then he shared something fascinating about statins that I hadn’t heard before:
“The building up of plaque in your vessels is an inflammatory process. That’s why the statins work… It wasn’t necessarily that we want to lower your cholesterol down. It’s nice that that happens, but we found out that the other key effect is that it reduces inflammation in your body and in the plaque.”
He recommended looking for natural supplements that help reduce inflammation, such as antioxidants and turmeric. He also emphasized that food is medicine, suggesting an anti-inflammatory diet as key for PAD patients. This aligns perfectly with what we’ve been sharing in our educational materials.
Our Fan-Favorite Segments with Dr. Rowe:
At the Global PAD Association, we like to end our interviews with some signature segments that reveal more about our guest physicians and provide practical insights for our community. Dr. Rowe’s responses were particularly enlightening!
Journey to Diagnosis: The Back Pain Mix-Up
In our Journey to Diagnosis segment, I asked Dr. Rowe to share a commonly misdiagnosed presentation of PAD. His answer hit home for me:
“The most common is the lower back pain where patients are diagnosed as having a bad back, but it’s actually a circulation problem,” he explained. “The most easy thing would be just to check for a pulse. That’s an easy part of the exam, and that’s the part where it shouldn’t be missed.”
This is exactly why we developed our “shopping cart test” that we share with our community. If you’re at a store and leaning on the shopping cart alleviates your pain, it’s probably your back. If it doesn’t help and you still need to stop walking, it’s more likely PAD. These simple distinctions can save patients years of inappropriate treatments!
The Pulse: A Surprising Surgical Outcome
For our segment called “The Pulse,” where doctors share a case that taught them a valuable lesson, Dr. Rowe described a young man with a football injury that had damaged the artery behind his knee. After multiple failed stents, Dr. Rowe performed a bypass all the way down to the patient’s ankle.
“I was like, I don’t know if this is going to really help him walk. His foot will be nice and warm and have a lot of circulation, but I don’t know what will it do for his calf,” he admitted. “And I was really surprised that he’s able to walk, he’s able to work out, and he’s not complaining of anything in his calf muscles.”
The lesson? Sometimes improving circulation to one area can have unexpected benefits throughout the limb. This gives me so much hope for our patients who might be told they have limited options!
Six Minutes That Mattered: Overcoming Fear of Blood
In our “Spur of the Moment” segment, where we ask about the defining six minutes that mattered in a physician’s career, Dr. Rowe shared something deeply personal. He revealed that he almost didn’t become a doctor because he was afraid of blood!
“I was working in an emergency room as a volunteer,” he recalled, “and I just didn’t know which way I was going to go, because I was still having those episodes. And then I said, okay, this is it.”
As a person of faith, Dr. Rowe described this as a spiritual turning point where he reached out for divine intervention—and suddenly, the fear that had plagued him disappeared. “I knew that I was going to take this turn towards being a physician… that was my biggest defining moment of my life.”
I love how this story shows the very human side of our medical professionals and the personal challenges they’ve overcome to help patients.
Personal Best: Lessons from Cycling
For our “Personal Best” segment, where we explore how doctors excel outside the operating room, Dr. Rowe shared his passion for cycling and how it’s made him a better physician:
“How that sport helped me with what I do is that it says that I have to be prepared… I’ve learned that I have to be accountable and make myself the best I can possibly be for my patients and be there and bring it every day because it’s on me to be the best I can for them and no excuses.”
This commitment to personal accountability resonated deeply with me. At the Global PAD Association, we believe that both patients and doctors have responsibilities in the healing relationship, and Dr. Rowe exemplifies the physician side of that partnership.
Taking Action for Your Vascular Health:
My conversation with Dr. Rowe reinforced so many of the principles we advocate for at the Global PAD Association: early diagnosis, understanding the root causes of your condition, getting second opinions when needed, and embracing walking as medicine.
If you’re dealing with PAD or supporting someone who is, I encourage you to visit our website at padhelp.org or call our Leg Saver hotline at 1-833-PAD-LEGS. We offer free resources, including a structured walking programs, diet guidance, and connections to knowledgeable healthcare providers.
Remember, as Dr. Rowe emphasized, you are in charge of your vascular health. With the right information and support, you can take meaningful steps toward better circulation and quality of life.
This blog summarizes my interview with Dr. Vincent Rowe. The embedded video above contains our full conversation with additional details on PAD management and treatment.
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