When Your Doctor Says “Your Arteries Are Too Small to Treat” - What Every PAD Patient Needs to Know

By Kym McNicholas

“I’m sorry, but the arteries below your knee are just too small to treat.”

“We’ll need to do a bypass (and when you ask about the landing one they say, “Don’t worry about those small vessels below the knee.)”

If you or a loved one has heard statements like these from a doctor while battling peripheral artery disease (PAD), I need you to know something critically important: These dismissive statements should be immediate red flags.

The Dangerous Myth of “Too Small to Treat”

Every four minutes, someone in America loses a limb due to PAD and diabetes. What’s truly shocking (Every 20 seconds globally)? According to research published in the American Heart Association’s Circulation journal, more than 60% of all amputations in the U.S. are performed without a doctor ever conducting an appropriate angiogram (vessel imaging) before amputation.

Through the Global PAD Association’s Leg Saver Hotline, we’ve found that among more than 1,000 patients facing imminent amputation, 85% were either:

• Not offered an angiogram at all, or

• Told their vessels below the knee were “too small to treat” so doctors wouldn’t even try

This isn’t just disappointing—it’s dangerous. The truth is that these small vessels below the knee are precisely the ones that need to be addressed to save limbs.

The Bypass Misconception

Some patients are told they need a bypass procedure while being assured not to worry about those small vessels below the knee. This creates a dangerous misconception.

Here’s what patients need to understand: A bypass is like building a detour around a traffic jam. But that detour is useless if the roads it connects to are also blocked! Similarly, a bypass that delivers blood around blocked sections won’t help if the small arteries below the knee (where the blood needs to go) remain blocked.

For a bypass to be successful, there must be adequate “runoff” vessels below the knee to receive the blood being rerouted. This is why comprehensive treatment that addresses both larger and smaller vessels is so critical.

Why Doctors Have Been Reluctant

To be fair to the medical community, treating below-knee arteries has historically been challenging. These vessels are:

• Tiny (sometimes just 2-3mm in diameter)

• Often heavily calcified in patients with diabetes and kidney disease

• Prone to “recoil” (closing back up) after balloon angioplasty

• Located in areas where permanent stents risk being crushed by normal leg movement

But here’s the crucial point: “challenging” doesn’t mean “impossible,” and medical technology has advanced significantly.

The Medical Breakthrough Changing Everything

The recent FDA clearance of Reflow Medical’s SPUR retrievable stent system represents a game-changing advancement specifically designed to address those “too small to treat” vessels.

Unlike traditional stents that remain permanently in the body, this innovative technology:

• Temporarily expands the vessel with a scaffold that has tiny spikes

• These spikes create micro-fractures in the calcified vessel walls

• Makes the vessel more pliable and less likely to recoil

• Is completely removed after treatment, leaving nothing behind permanently

• Achieves stent-like results without the risk of stent crushing in those delicate areas

In clinical trials, this system achieved a 99.2% technical success rate and 97% freedom from major adverse limb events at 30 days.

Dr. Jay Matthews, who led the groundbreaking clinical trial, explains: “By essentially puncturing that calcium and creating all these micro-fractures, it makes the vessel a lot more pliable and flexible… The vessel seems to stay open, even though the stent is not there.”

What This Means For You as a Patient

If you’ve been told your vessels are “too small to treat” or that a bypass is needed without addressing below-knee arteries, here’s what you should do:

1. Always seek a second opinion from a specialist with expertise in critical limb ischemia (CLI) and complex below-knee interventions

2. Ask specific questions like:

   • “What options exist for treating my below-knee arteries?”

   • “Are you familiar with newer technologies like retrievable stent systems?”

   • “How many limb salvage procedures do you perform annually?”

3. Request an angiogram before accepting amputation as inevitable

4. Contact the Global PAD Association’s Leg Saver Hotline at 1-833-PAD-LEGS for support and referrals

Remember, as Dr. John Phillips powerfully stated in my recent interview: “We’re not into products. We’re into patients.” The physicians who truly embody this philosophy are the ones who will explore every possible option before considering amputation.

The Patient Perspective That Matters

While the medical system often views repeated interventions as a costly “revolving door,” patients facing amputation have a completely different perspective. When the alternative is losing a limb, most patients gladly accept multiple procedures if it means keeping their leg.

For them—for you—each procedure buys precious time and maintains quality of life. Your desire to keep your limb, even if it requires multiple treatments, is valid and should be respected.

You deserve to walk to live another day and live to walk another day!

Walking Remains Essential

Even with these exciting new technologies, walking remains the best medicine for PAD. Patients need to walk, walk, walk to grow collateral vessels that reroute blood flow around blockages. These procedures are meant to heal wounds and provide enough pain relief so you can get back to walking—growing your own natural bypasses through exercise.

The Global PAD Association has a structured walking program to help patients with PAD track their improvement over time. You can sign-up for “My Step” using this link HERE. But make sure you have your doctor’s permission as it’s required since patients have different presentations of disease and your physician should have access to the dashboard to monitor your progress.

A Final Thought

Medical innovation is continuously advancing, creating new possibilities for conditions once considered untreatable. The first time someone told Coach Prime, Deion Sanders, that amputation was inevitable because his vessels would close back up, he sought other options—and kept both his legs.

You deserve the same opportunity to benefit from the latest advances in medical technology. Don’t accept “too small to treat” as the final word on your condition. Your limbs are worth fighting for.

For more information about PAD and treatment options, visit Global PAD Association or call the Global PAD Association’s Leg Saver Hotline at 1-833-PAD-LEGS.

Disclosure: Reflow Medical is a sponsor of our “Heart of Innovation” show. As an Emmy award-winning journalist, I would never accept a sponsorship from a company if I did not believe in their mission. This article about their FDA clearance was created with complete journalistic integrity because I truly believe, as the FDA did in granting their de novo clearance, that this technology represents a significant advancement for patients with PAD.