Low income PAD patients chose stent over exercise

May 19, 2016

CHICAGO, Illinois - Conventional wisdom might suppose that everyone would avoid surgery if possible.

But a research team in Houston has found that veterans who could choose between regular exercise or a surgical procedure to improve their leg pain 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.

Vascular surgeon and principal investigator Dr. Neal Barshes and researcher Sherene E. Sharath surveyed 102 military veterans affiliated with the Michael E. DeBakey Veterans Affairs Medical Center in Texas. They will present their findings at the 2016 Vascular Annual Meeting sponsored by the Society for Vascular Surgery in June near Washington, D.C.

The patients were mostly male, 65 or older and suffering from leg pain due to peripheral arterial disease (PAD). PAD is a chronic disease caused by plaque buildup in the leg arteries due to atherosclerosis, or hardening of the arteries. Patients who preferred a stent solution over exercise were likely to: 

  • Know someone else who had gotten a stent
  • Have a lower socioeconomic status
  • Smoke cigarettes

“We don’t know exactly why there is a correlation with smoking,” said Barshes. “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.”

The team was interested in how perceptions and beliefs related to interventions, said Sharath, who is doing her dissertation on public health and epidemiology, with a focus on PAD pain.

“We thought that economic disadvantage might just be a proxy for lack of adequate exercise facilities or sidewalks,” she said. “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.” Some neighborhoods might be less safe for walkers and may not have good sidewalks or walking routes.

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

“The reasoning behind this belief is something that we would have to measure and examine in the future,” Sharath said. “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.”

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

The team said physicians don’t try to influence the patient’s decision.

“I wouldn’t feel comfortable trying to sway them using what we know at the moment,” Sharath said. “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.”

The Society for Vascular Surgery® (SVS) is a 5,400-member, not-for-profit professional medical society, composed primarily of specialty-trained vascular surgeons, which seeks to advance excellence and innovation in vascular health.

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