By Kym McNicholas, Chairman & CEO of the Global PAD Association

Research is the foundation of progress in medicine, particularly in peripheral artery disease (PAD). It’s how we learn, it’s how we improve, and ultimately how we save more lives and limbs. When it comes to PAD research—a disease more prevalent and deadlier than most cancers combined—no team has shown more dedication and strategic vision than this year’s recipients of the Global PAD Research Team of the Year Award.

Through their leadership, they’ve facilitated groundbreaking studies examining intervention effectiveness, disease progression, and quality of life improvements for PAD patients. Most importantly, they ensure research dollars go directly towards the studies with the greatest potential to improve real-world outcomes for people living with PAD.

I sat down with Dr. Saratzis and Dr. Bown to learn more about their work and vision for the future of PAD research.

Building a Patient-Centered Research Framework

Six years ago, the team identified a significant problem: PAD research was being overlooked by major funding bodies in favor of more publicly recognized conditions.

“We were very aware that in terms of research funded in the UK, peripheral arterial diseases were falling away,” Dr. Bown explained. “Funding agencies like the British Heart Foundation and governmental funding agencies such as the National Institute for Health and Care Research were directing resources toward diseases that had perhaps a bigger public presence.”

To change this, they implemented a James Lind Alliance priority setting process, bringing together clinicians, patients, and community members to identify and rank research priorities through a structured approach called a Delphi process.

“Once we had that short list of research priorities, we could go to the funders and say, ‘This is research being asked for by the population and by our patients,’” Dr. Bown said. “The funders really can’t reject that as an idea.”

This methodical approach uncovered a significant disconnect between clinical and patient priorities. While medical professionals often focus primarily on mortality rates, patients frequently expressed different concerns.

“Patients have changed the way I think about what really matters,” Dr. Saratzis said. “Many times we’ve heard from patients that they might value not losing their leg more than mortality itself. Some patients have expressed that they want to live an independent life for as long as possible, but if they end up with an amputation, they feel that would be a very major event.”

The top research priorities that emerged from this process include improving outcomes after surgery, determining optimal exercise approaches, earlier diagnosis, and developing new treatments.

The team also addressed the traditional competition between medical centers and specialists.

“Surgeons have a fairly bad reputation for not collaborating,” Dr. Bown acknowledged. “Back in the 80s and 90s, it was about what you could do as an individual to make your center better than the one down the road.”

Through the Vascular Society, they’ve created a collaborative environment that includes not just surgeons but physical therapists, nurses, imaging specialists, and other professionals involved in vascular care.

“The vascular society doesn’t just represent vascular surgeons,” Dr. Bown emphasized. “It represents all sorts of clinical specialties involved in the care of people with vascular diseases. So that includes physical therapists, occupational therapists, specialist vascular nurses, people interested in vascular imaging.”

Major Research Initiatives

The team’s strategic approach has yielded approximately 12 research trials currently running. Dr. Bown explained that these aren’t just observational studies but comparative trials: “We’re actually doing things like comparing medications or comparing surgical treatments. And in particular, in this field, lots of new things are coming out fairly regularly.”

Comparative Treatment Trials

Several of their studies are focused on comparing different interventions. Dr. Saratzis mentioned large trials like BASIL-2, BASIL-3, and the American BEST-CLI trial, which compared different treatment approaches for critical limb ischemia.

While these studies didn’t show major differences between treatments in terms of amputation-free survival, they’ve provided valuable insights that are shifting research focus: “This is probably why we’re now moving from just comparing stent A or balloon A to stent B to other things like exercise, lifestyle advice, better medical therapy, because we think that this is where we might indeed improve things in terms of preventing amputations and preventing death.”

Exercise Studies

The team is conducting several innovative studies focused on exercise interventions for different PAD patient populations.

The HOPE study addresses patients who have undergone or are about to undergo surgery for severe PAD. “We are trying to develop an exercise regime after and immediately before surgery for people who have got gangrene in their legs or rest pain,” Dr. Saratzis explained. “That’s not been done before because we always thought that it’s best to just do the surgery and then see what happens.” The intervention is almost finalized, with results expected to be published within six months.

When I mentioned Dr. Lily Johnston, a vascular surgeon in California who expressed interest in research on resistance training for PAD patients, Dr. Saratzis confirmed that resistance training is being considered as part of the HOPE program: “Within the HOPE program that I very briefly discussed, which is for people that have undergone surgery or are about to undergo surgery, this is something that we’re looking into.”

For patients with intermittent claudication (pain when walking), the Mosaic program is developing specialized home-based exercise interventions. Led by Professor Lindsay Byrne, a physiotherapist based in London, this program aims to make exercise therapy more accessible. “She’s trying to get a preliminary intervention that she developed for exercise at home for people with claudication, finalize it now over the next few months, and then test it in a big randomized trial,” Dr. Saratzis said.

Dr. Saratzis shared a compelling example of how consistent exercise can transform outcomes. He described a patient with claudication who, after undergoing a procedure to open an artery in their thigh, showed only modest improvement. However, when the patient began playing tennis daily on a private court built by their partner, they became virtually pain-free within six months. “It reiterates the importance of daily exercise,” he noted, adding with a smile, “But I don’t think everyone can afford to build a private tennis court.”

These exercise studies address a common frustration among patients who ask, “Can’t we just diversify? Why do we just walk?” It’s particularly important for those with rest pain or wounds who cannot engage in walking-based exercise programs.

Screening and Follow-up Studies

The team is conducting pilot studies on screening healthy populations for PAD, with a particular focus on maintaining lifestyle modifications after diagnosis.

Dr. Bown explained their approach to ensuring patients maintain positive behavioral changes: “We’re setting up a system whereby what we’ll do is we’ll actually have a nudge people because this is a long-term thing and you’re going to have to keep doing this over a long period of time. So we kind of settled on a year because that’s literally just a friendly phone call once a year to go, ‘Are you still taking your statin? Are you still walking?’”

They’re also investigating better follow-up protocols with ultrasound for patients who have had procedures, to see if it improves prognosis and helps with accountability in maintaining lifestyle modifications.

Real-World Impact

Rapid Access Clinics

One of the team’s most significant achievements has been the establishment of rapid access clinics across the UK based on their research findings.

Dr. Bown explained: “There’s been some research in terms of if you see people quickly and treat them quickly, what happens is you improve outcomes in terms of preventing limb loss.”

This research has translated into a practical healthcare delivery model that allows community physicians to refer patients more quickly, reducing wait times for specialist evaluation.

“We’ve managed to show that you can decrease the amount of time people wait to be seen in a specialist clinic,” Dr. Bown said. “It certainly feels like it when you’re a clinician treating people - you’re seeing people much quicker and you don’t have those people turning up to your clinic who’ve perhaps waited two or three months in the system. And then they’ve got to the stage where you can’t help them.”

Improved Patient Engagement in Research

Across all their initiatives, the team has made patient inclusion a cornerstone of their approach. Dr. Saratzis detailed how patients have influenced everything from outcome selection to study logistics:

“When it comes to study delivery, the patients are extremely helpful when it comes to designing the information leaflets and the documents that we give to potential participants, as well as designing things like the type of assessments that they undergo during the study. So when is it best to call them back for follow-up? Is it okay if they have an ultrasound, or would they prefer some other type of scan?”

Both researchers highlighted the importance of patient involvement in driving research forward. Dr. Bown shared how a letter from eight patients to the UK’s chief scientific officer accomplished in two days what he had been unable to achieve after months of effort – advancing a stalled research project.

“A group of eight patients write a letter to the chief scientific officer. Two days later, I’m assigned a personal manager at NHS England to get the research project moving,” he recounted. “The game changer is not necessarily going to be what trial delivers in the next five years. It’s going to be, can we maintain this level of involvement of the public and patients in the actual delivery aspects of the research?”

Challenges and Future Directions

Despite their structured approach, significant challenges remain. When asked about research showing promise in reducing amputation rates, Dr. Saratzis was candid.

“We’ve never shown in a big study that some form of intervention actually reduces amputation rates or amputation-free survival,” he said. “This is why we’re now moving from just comparing devices to exploring exercise, lifestyle advice, and better medical therapy.”

Dr. Saratzis emphasized that recruitment is one of their biggest challenges: “Recruitment is behind and will be behind due to a number of problems like equipoise, for example. Some surgeons, radiologists, cardiologists, some of us already think that we know the answer to everything. Then there are major bureaucratic problems in terms of opening hospitals for recruiting in certain studies, and of course, there’s money involved.”

He added, “For me, the major thing in the next five years is to recruit into those big trials. Otherwise, we’re back to zero.”

Cathy, an administrator for our UK community support group, pointed out during the interview that many patients remain unaware of these research efforts: “Most patients have no idea that any of this research is happening because their experience at the sharp end is that people don’t care, that they wait a long time, that they don’t feel that they have enough time when they see people.”

She added that greater awareness of research could increase patient engagement: “I think if we’re able to get that message out to people, they’ll become more engaged. There’s quite a lot of people who like to say this just isn’t good enough, but they don’t understand the mechanism or they’re not able to get involved.”

Getting Involved

The Global PAD Association continues to support the work of researchers like the PAD Specialist Interest Group by connecting them with our patient community, which includes nearly 2,000 members in the United Kingdom alone.

For those interested in participating in clinical trials, especially in the UK, visit padtrials.org to learn about research opportunities through the NHS and beyond. Dr. Saratzis mentioned that they're finalizing documents and infographics for primary care doctors to improve PAD referrals, which should be available before Christmas.

Additionally, patients can visit Vascular Research UK, led by the Vascular Society, which provides details for studies with contact emails to reach the right person for each study.

Connect with others through our UK Facebook group or our walking group at walkingsupportgroup.com.

Disclaimer: Global PAD Impact Awards are based on nominations from patients and evaluations by an independent panel. They should not be considered an endorsement for any specific doctor or treatment approach. Always do your own research to find the best care for your situation. For personalized help finding appropriate care, contact the Global PAD Association’s hotline.