No treatment options from consultant.

@BlueSilverCats I’m so sorry you are having to deal with this, it’s really tough, especially when it’s your loved one who has to make the necessary changes. It’s a horrible addiction in that some people will never give up even when they know it will lead to their death….I do hope your OH can make that choice, sometimes people need to understand that it’s not just atherosclerosis in the legs that will be occurring it will be happening in the major vessels too and puts him at increased risk of heart attack or other cardio- vascular events. Have you any other family members or friends who he listens to , that might be persuaded to talk it over with him?

That is a nice clear letter with very clear advice. There's no option to bypass because all the alternative routes are also in trouble. Stopping smoking and walking IS the treatment. That's not doing nothing,that's the treatment. It's just very hard.

Looks like the consultant is trying to be clear and honest.

Simply put there is no treatment option, and if he doesn't stop smoking immediately he will lose his leg, at best.

This is literally last chance saloon. It's clear from the letter he'd already been told to stop smoking, and hasn't.

Has he tried Stop Smoking Therapy before ?

They can help if the smoker wants to stop but if they choose to continue they're limited .Our local services asks "Are you ready to stop smoking" and if they answer "Not really" or "no" then they don't proceed /
Choose isn't the "right" word , smoking is so addictive , Though the banning of smoking in most public places and the ££ it costs are a good incentive to quit .

my.clevelandclinic.org/health/articles/23560-collateral-circulation

Yes collaterals are what will save the leg if he follows advice and exercises and stops smoking .

No second option would change that , the op would be futile and presumably the second consultant had a clearer picture after the MRI hence the difference of opinion

I’m no doctor and don’t know rhe soecifc details, but from what you have said the doctor gave the right advice…

www.nhs.uk/conditions/peripheral-arterial-disease-pad/treatment/

Smoking cessation is likely not a gp service in your area but there will be a stop smoking service. Some times is pharmacy led or a service like ‘quit your way’ put it into google with your area and see what service is available.

It's cos all the main flow pathways down the leg are blocked. Once they're totally clogged off you can't stent them open, and the vessels they'd consider as bypass routes to revascularise are also blocked

Collateral are when bits of the body with poor blood supply make alternative tiny routes through... u can improve them as said in the letter

He's at huge risk of amputation if keeps smoking, sorry x

That letter really is a wake-up call.
Your husband needs to have it on the fridge and on his phone prominently to jolt him when he thinks about a smoke .

He sounds like his feet / foot are really vunerable (and there will be evidence available about the risks of gangrene and amputation which is a huge risk)

He needs to make sure there's no trauma to his feet and legs , if he works outdoors then his footwear needs to protect him. Check for holes and seams which can rub . Things like grit or stones in the shoes .
Indoors no barefeet .

But the smoking - yes he does need to quit , it;s good that he has cut down , he must;ve been suffering symptoms of the PAD to make him do this , but he needs to go non smoker .

this in a nutshell

stop smoking, exercise by walking or lose the leg and/or his life

bluntly

Ok, so essentially the blockages are too widespread, and too distal (in the lower leg) for angioplasty or bipass surgery. He has some evidence of new vessels opening up to compensate for the blocked ones, and exercise will encourage more to open up. Stop smoking so things don’t get worse.

very good advice on here

possibly copy the letter wording here? may be more understandable

What's wrong with his foot?
Does he have diabetes ?

Post the letter -
It may be clearer

You seem very confident that he'll be able to make the necessary lifestyle changes @BlueSilverCats . Are you prepared for the idea that he may not. He hasn't so far and they're very difficult things to do.

They can often try if it's limb saving ie.acutely ischaemic but often unsuccessful as often the vessels they're trying to graft onto the inital problem are just as awful. It's super stressful when they're trying to do emergency cases

I'm an anaesthetist not vascular surgeon though, I'd def ask for a 2nd opinion

That's mad they've refused to prescribe, can he book in with the nurse for smoking cessation.appts - most gps won't prescribe outside of a treatment programme as there's a lot of evidence now that drugs alone aren't enough they need the ongoing support too (my mums been refused meds as didn't want to attend the classes/appts

Very unlikely. Vascular patients are one of the most crumbly frail people we anaesthetise for (often with little choice when ischaemic limbs become infected or such and its life saving). We consent that they could be very high risk for not surviving but can't say ever not gone ahead unless imminently dying anyway which surgery wouldn't change the prognosis. We can do a lot of lower limb stuff under spinal anaesthetic and the surgeons are used to doing a lot under LA due to the nature of their patient group (if their leg vasculature is furred up the same will be said for their heart/brain/kidneys etc

I’m sorry to hear this. I would definitely get a second opinion and if this is going to take a long time, try to go private if you can. Something is not adding up with the 2 different consultant opinions. And as the consequences for your OP could be severe I would have thought he’d want to be sure what the options are. Nothing stopping lifestyle changes alongside getting another opinion. Quite possibly not in this case, but I am aware that some Drs “fob off” people when the don’t have a great understanding of the illness or just want to get the patient off their list.