Home Decision Aid

Decision Aid

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What are your preferences and values as they relate to your PAD treatment?

Use this Decision Aid to Compare Pros and Cons of Non-Invasive and Invasive Treatment Options for PAD Symptom Relief

Scroll down to assess your preferences. Use this personalized worksheet as a guide to discuss your preferences and values with your PAD provider at your next visit.

How will treatment affect
my symptoms and quality of life?

Supervised Exercise Therapy

Non-Invasive Option

PROS

  • Can significantly improve symptoms and increase walking distance
  • Regular exercise is proven to lower risk of heart attack or stroke and improve survival over time
  • May improve quality of life in a meaningful way

CONS

  • May take longer to notice improvement
  • Need to be cleared by your provider to exercise; side effects are rare
Strong evidence — Benefit outweighs risk

Claudication Medications

Non-Invasive Option

PROS

  • May improve PAD symptoms and increase walking distance in some patients

CONS

  • May take several weeks to notice improvement
  • Some patients may experience side effects
  • Claudication medications are not known to lower your risk of heart attack or stroke
Strong evidence for cilostazol (Pletal) — Benefit outweighs risk
Evidence of harm for pentoxifylline (Trental) — Risk greater than benefit

Angioplasty | Stents | Bypass Surgery

Invasive Options

PROS

  • Can significantly improve symptoms and increase walking distance
  • May improve quality of life in a meaningful way

CONS

  • Results may not last over time; may need repeated procedures
  • Not everybody is a good candidate
  • Invasive treatments for PAD symptom relief do not lower your risk of heart attack or stroke
Benefit or risk of each procedure depends on the severity of your symptoms, the condition of your arteries, the location of your blockage(s), and your overall health.
Talk with your provider to understand the risks and benefits.

How quickly can I return
to my normal activities?

Supervised Exercise Therapy

Non-Invasive Option

PROS

  • Exercise does not prevent you from normal activities

CONS

  • Pain may still be experienced as you work your way up to walking longer
  • May take longer to notice improvement
  • Need to be cleared by your provider to exercise; side effects are rare
Strong evidence — Benefit outweighs risk

Claudication Medications

Non-Invasive Option

PROS

  • Taking medications does not prevent you from normal activities

CONS

  • May take several weeks to notice improvement
  • Some patients may experience side effects
Strong evidence for cilostazol (Pletal) — Benefit outweighs risk
Evidence of harm for pentoxifylline (Trental) — Risk greater than benefit

Angioplasty | Stents | Bypass Surgery

Invasive Options

PROS

  • Angioplasty and stents are same-day outpatient procedures that usually do not require hospitalization
  • Pain relief typically noticeable shortly after recovery and healing

CONS

  • Bypass surgery may require several days of hospitalization
  • Invasive procedures require recovery time at home (days to weeks)
  • Risks associated with invasive procedures can include but are not limited to:
    • Angioplasty and Stents: bleeding, infection, kidney damage
    • Bypass Surgery: bleeding, infection, anesthesia complications
Benefit or risk of each procedure depends on the severity of your symptoms, the condition of your arteries, the location of your blockage(s), and your overall health.
Talk with your provider to understand the risks and benefits.

Patient Outcomes

Patients participating in the PORTRAIT study completed a questionnaire about their quality of life and PAD symptoms one year after being diagnosed with peripheral artery disease. These bar charts show patients’ outcomes related to different types of treatment.

Cost of Treatment Tips

  • Supervised exercise therapy is approved and covered by Centers for Medicare and Medicaid Services (CMS). Your provider can prescribe this program. Also check with your insurance provider about coverage.
  • Community health centers may provide exercise programs at low cost if no supervised exercise program is available.
  • Generic versions of claudication medications may be available at lower cost.
  • Invasive procedures are the most costly form of PAD treatment.
  • Out-of-pocket costs will vary depending on the hospital, pharmacy, region of the country and your insurance coverage.
  • Ask for written information about treatment options and contact your insurance provider before undergoing treatment to find out about costs and coverage.
  • Consult online resources, such as HealthcareBluebook.com, to look up reasonable rates for medical tests and treatments in your region.

Rate Your Preferences and Values

Think about what matters most to you as it relates to your PAD treatment and share this assessment with your provider.

How important is it for you to…

Favors invasive options
Favors non-invasive options
Try exercise and medications first to relieve PAD symptoms
Not at All Important
<<<<<<
Very Important
>>>>>>

How concerned are you about…

Favors invasive options
Favors non-invasive options
The risk associated with a procedure/surgery
Not at All Important
<<<<<<
Very Important
>>>>>>
Repeated invasive procedures
Not at All Important
<<<<<<
Very Important
>>>>>>
Timeline of symptom relief
Not at All Important
<<<<<<
Very Important
>>>>>>

Outcomes I value…

My quality of life
Not at All Important
<<<<<<
Very Important
>>>>>>
Return to daily activities
Not at All Important
<<<<<<
Very Important
>>>>>>
Cost of treatment
Not at All Important
<<<<<<
Very Important
>>>>>>
Risk of losing toes or legs
Not at All Important
<<<<<<
Very Important
>>>>>>
Risk of heart attack or stroke
Not at All Important
<<<<<<
Very Important
>>>>>>
Risk of dying because of cardiovascular disease
Not at All Important
<<<<<<
Very Important
>>>>>>
My ability to quit smoking
Not at All Important
<<<<<<
Very Important
>>>>>>
My ability to make lifestyle changes
Not at All Important
<<<<<<
Very Important
>>>>>>

Questions to Ask Your Provider

Take the opportunity to ask your doctor questions during your next appointment.

LIFESTYLE CHANGES & CARDIOVASCULAR RISK MANAGEMENT

  • What can I do to lower my cardiovascular risk?
  • What are good resources to help me quit smoking?
  • How do my other medical conditions affect my PAD treatment decisions?
  • What if I don’t make a treatment decision now?

COST OF TREATMENT

  • What are my individual costs for the PAD treatments available?
  • Which department or contact can I speak with to find out more information about costs?

TIMELINE OF RETURN TO NORMAL ACTIVITIES

  • How quickly can I return to work or normal activity after my treatment?
  • What activities can I engage in? What will I need to avoid?
  • Does my condition make me a high-risk or low-risk candidate for invasive procedures?

SYMPTOM RELIEF & QUALITY OF LIFE

  • What kind of exercise is recommended?
  • Are community or home-based exercise programs as effective as supervised exercise programs for PAD?
  • What treatment will help me achieve the quality of life I want to have?
  • What are the side effects of claudication medications?
  • What other changes would I need to make after an invasive treatment?

RISK OF AMPUTATION

  • Why is it important to examine my feet on a regular basis?
  • What are healthy foot care behaviors?
  • What signs or symptoms should cause me to act promptly to avoid worsening of PAD and to avoid loss of toes or legs?

What’s Next?

Take advantage of the resources available here to prepare for your next doctor visit:

  1. Print the materials on this page
  2. Watch the Patient Stories and Provider Perspectives videos
  3. Write down your own questions
  4. Bring everything to your appointment with your PAD provider

Follow these steps to learn about PAD