The Four Specialists Who Can Treat Peripheral Artery Disease
If you or a loved one has been diagnosed with Peripheral Artery Disease (PAD), you may be wondering who to turn to for treatment. The truth is, there isn’t just one type of doctor who can help—there are four distinct medical specialties equipped to treat this condition, each bringing valuable skills to the table.
Vascular Medicine Specialists
These physicians focus on the diagnosis and medical management of vascular diseases. They typically serve as the frontline of PAD treatment, using:
Medications to improve blood flow
Lifestyle modification plans
Conservative approaches to manage symptoms
Every PAD patient should work with a vascular medicine specialist, as these conservative approaches form the foundation of effective PAD management.
Vascular Surgeons: Masters of Both Open and Hybrid Techniques
Vascular surgeons specialize in surgical procedures to restore blood flow throughout the body (except the heart). Their surgical expertise is particularly valuable for complex cases that may not be suitable for endovascular treatment alone.
Advanced Surgical Techniques:
Bypass Surgery: Vascular surgeons can create detours around blocked arteries using various approaches:
Fem-pop bypass (femoral to popliteal): Reroutes blood from the thigh to below the knee
Fem-tib bypass (femoral to tibial): Creates a pathway from the thigh to the lower leg arteries
Aorto-bi-femoral bypass: Addresses blockages in the abdominal aorta and both femoral arteries
These bypasses can be constructed using either the patient’s own veins (autologous) or synthetic grafts
Endarterectomy: This technique remains the gold standard for treating blockages in the common femoral artery (the artery in the “bendy spot” where your leg meets your torso). During this procedure, surgeons:
Make an incision directly over the artery
Open the vessel
Physically remove the plaque buildup
Repair the artery with a patch
This approach provides durable, long-lasting results for this critical location
Minimally Invasive and Hybrid Approaches:
Many modern vascular surgeons also offer a comprehensive range of minimally invasive techniques either independently or in combination with targeted surgical approaches:
Angioplasty: Inflating specialized balloons to open narrowed vessels
Atherectomy: Using specialized devices to remove plaque
Thrombectomy: Removing blood clots
Lithotripsy: Breaking up calcified lesions
Stenting: Placing mesh tubes to keep arteries open
Hybrid Procedures:
A key advantage of vascular surgeons is their ability to perform “hybrid procedures” that combine the best of both worlds:
Open surgical access to the most diseased segments
Endovascular techniques for treating more distal or diffuse disease
Single-session treatment of complex, multilevel disease
While vascular surgeons offer essential services, patients should ensure their vascular surgeon collaborates with cardiologists, as many PAD patients also have heart conditions requiring evaluation.
Interventional Cardiologists (ICs)
Interventional cardiologists bring a unique perspective to PAD treatment. Their expertise stems from years of navigating the heart’s complex, small, and constantly moving arteries—arguably some of the most challenging vascular territory in the body. They’ve also been at the forefront of some of the greatest advances in minimally invasive tools and techniques for both the legs and the heart.
What makes their skillset particularly valuable for PAD patients:
Transferable expertise: If they can work on small, twisting coronary arteries while the heart is beating, they can effectively handle the straighter, more stationary arteries in the legs, clear into the foot when medically appropriate
Comprehensive vascular view: They understand the relationship between coronary artery disease and PAD, which often coexist
Advanced minimally invasive techniques including:
Angioplasty (balloon dilation of narrowed arteries)
Atherectomy (removal of plaque)
Thrombectomy (removal of blood clots)
Lithotripsy (breaking up calcified lesions)
Stenting (placing mesh tubes to keep arteries open)
The cardiovascular expertise of interventional cardiologists is particularly valuable since three out of five people who suffer a heart attack also have PAD. This makes them uniquely positioned to address both conditions simultaneously, providing comprehensive care for the entire vascular system. It’s important they have a relationship with a vascular surgeon with whom they can refer patients when medically appropriate and understand how to maintain the ability for surgical options when endovascular methods fail.
Interventional Radiologists (IRs): Pioneers of Endovascular Treatment
Interventional radiologists hold a special place in PAD treatment history as the pioneers of endovascular therapy for legs in the U.S. Their story includes one of the earliest significant breakthroughs in limb salvage in America:
The Oregon Case: Birth of Endovascular Limb Salvage
In the early days of endovascular medicine, an interventional radiologist made history by performing the first minimally invasive procedure in the U.S. to save a woman’s leg from amputation. This groundbreaking case in Oregon demonstrated that blocked leg arteries could be treated without major surgery—opening a new frontier in PAD treatment that has since saved countless limbs.
Today’s interventional radiologists bring exceptional skills to PAD treatment:
Advanced imaging expertise: Extensive ability to visualize complex arterial anatomy in real-time
Whole-body vessel navigation: Experience treating blood vessels throughout the entire body (lungs, kidneys, liver, and limbs)
Precision techniques: Using specialized wires and catheters to cross even the most challenging blockages
Minimally invasive procedures including:
Angioplasty
Atherectomy
Stenting
Specialized techniques for completely blocked arteries
Their background in imaging at the foundation of their education, just as with Interventional Cardiologists, gives them a distinct advantage in visualizing and navigating the most complex arterial anatomies, particularly in cases where blockages are difficult to cross or treat. It’s important they have a relationship with a vascular surgeon with whom they can refer patients when medically appropriate and understand how to maintain the ability for surgical options when endovascular methods fail. It’s also important they have a relationship with cardiologists so they’re patients have a proper cardiovascular evaluation prior to any procedures.
Skills Matter More Than Titles: Finding the Right Specialist for Your Needs
When it comes to PAD treatment, the most important factor isn’t the specialty on a doctor’s business card—it’s their specific skillset and experience treating your type of condition. Across all four specialties, the most effective providers share certain advanced capabilities that can make the difference between saving and losing a limb.
Advanced Techniques That Transcend Specialty Boundaries
Look for providers who can:
Navigate the entire arterial tree: Particularly the ability to treat small vessels below the knee and into the foot’s arterial loop—critical for wound healing and limb salvage
Utilize multiple access approaches: Not just the traditional approach from above (groin access), but also from below (foot or ankle access) when necessary to cross difficult blockages
Perform complex interventions: Including specialized techniques for calcified lesions, chronic total occlusions, and bifurcation lesions
Offer “Hail Mary” options for critical cases:
Deep vein arterialization (DVA): A technique that hijacks veins to reroute blood when arteries are completely blocked
Percutaneous transluminal angioplasty and bypass (PTAB)
Surgical options like bypass and endarterectomy when endovascular approaches aren’t sufficient (even through referral)
Work collaboratively: The best specialists recognize when another’s expertise might better serve a patient and refer accordingly
Questions to Ask When Choosing a Specialist
When evaluating potential PAD specialists, consider asking:
“Do you treat arteries below the knee and into the foot when necessary?”
“What techniques do you use for heavily calcified blockages?”
“Can you approach blockages from both above and below if needed?”
“What cutting-edge options do you offer for patients with no traditional treatment options?”
“Which other specialists do you collaborate with regularly?”
“How many PAD cases like mine do you treat monthly, and with success?”
The Multidisciplinary Advantage
The most comprehensive PAD care often comes from centers where multiple specialists collaborate, bringing their complementary skillsets to each case. This multidisciplinary approach ensures that patients benefit from the full spectrum of available treatments.
The Importance of Multiple Opinions
It’s alarming that more than 60% of amputations are performed without doctors even attempting to open blocked arteries—a practice that goes against national PAD management guidelines.
Before undergoing any procedure:
Get a second opinion
Consider a third or fourth opinion if necessary
Explore whether a structured walking program, lifestyle changes, and medication might be effective without procedural intervention
Finding the Right Care Team
PAD treatment requires a multidisciplinary approach, and no single specialty is right for every patient. Your choice should depend on:
Your specific condition and its severity
Local availability of specialists
Insurance coverage
The specific skill sets of available providers
If you need assistance finding appropriate care, the Global PAD Association offers resources through their website at padhelp.org or via their Legsaver hotline at 1-833-PAD-LEGS.
Remember: Managing PAD is a journey, and finding the right specialist—regardless of their title—can make all the difference in your vascular health outcomes. The key is finding someone with the right skills for your specific situation, who works collaboratively with other specialists when needed.
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