Dr. Nicolas Mouawad: PAD Doctor of the Year for Limb-Saving Approach to Care

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

In the world of PAD treatment, artificial boundaries often separate vascular surgeons, interventional radiologists, and interventional cardiologists. But patients with peripheral artery disease don’t care about practice titles or specialty distinctions. They simply need a physician who will do everything possible to save their limbs and improve their lives.

It’s a debilitating disease—poor circulation mainly in the legs causing leg cramps, pain, and neuropathy, making it difficult for patients to walk. So it’s really about “How do you relieve my pain and give me a better quality of life?” That’s what patients care about.

That’s why this year’s PAD Doctor of the Year Award transcends all these traditional practice divisions to recognize excellence in PAD care in its purest form: a physician who consistently goes above and beyond for every single patient, regardless of specialty framework.

Dr. Nicolas Mouawad exemplifies this patient-first philosophy. As chief of vascular and endovascular surgery at McLaren Health Management Group in Bay City, Michigan, he has earned impressive credentials, including recognition on Newsweek’s America’s Best Vascular Surgeons list. But what truly distinguishes him is his relentless commitment to exploring every possible option for limb salvage when others might consider the case hopeless. That's why patients nominated him for this year's "PAD Doctor of the Year" through the Global PAD Association 's Global PAD Impact Awards.

When Others Say “No,” He Says “Let’s Try”

Consider a patient who came to the Global PAD Association scheduled for amputation at another hospital. When I messaged Dr. Mouawad about the situation, he immediately offered to help, even preparing for a potential hospital-to-hospital transfer if necessary.

It turned out the amputation wasn’t immediately necessary—life wasn’t on the line. The vascular surgeon at the other hospital discharged the patient so they could seek a second opinion. Dr. Mouawad stepped up and said, “If no one else will try, I will try.” He quickly provided intervention using advanced revascularization techniques that weren’t previously explored. Today, that patient walks on their own two feet.

This story repeats itself throughout Dr. Mouawad’s practice. His clinical ingenuity shines brightest when conventional treatment algorithms fall short. He actively participates in cutting-edge research to create new possibilities for patients who’ve been told nothing more can be done to save their legs.

“I’m just doing what I wish somebody would do for me, what we would want somebody to do for our family,” Dr. Mouawad said upon accepting the award. “I’m just doing my job and trying my best to give people the quality of life that they deserve, that they want. They really just want somebody to try. That’s all I’m asking for. That’s all I’m trying to do.”

The Defining Moment: A Pattern of Premature Amputations

This commitment to trying when others won’t didn’t develop overnight. When asked about a defining moment in his career, Dr. Mouawad points to a troubling pattern he noticed years ago that fundamentally changed his approach to vascular care.

“We have a big catchment area, and what really kind of dinged the light bulb for me is a lot of patients get referred for an amputation. They don’t get referred for a vascular evaluation. They don’t get referred for assessment or imaging. They get referred for the amputation.”

Since vascular surgeons often perform amputations—whether for orthopedic, trauma, infection, diabetic, or vascular reasons—patients frequently came to him already scheduled for the procedure. What he discovered was disturbing: many of these patients didn’t actually need amputations.

“I had a slew of these referrals or consults for these patients where they didn’t need it. The leg required a lot of work, but we were able to save them,” he recalls. “It was at that point where I was like, ‘Wow, it’s not necessarily the procedure. It’s that they’re being there.’”

This realization—that some patients might lose limbs simply because they weren’t evaluated by someone with the right expertise—has driven his “why not try” philosophy ever since.

Why Not Try?

In a medical landscape where many physicians wait for more evidence before attempting innovative approaches, Dr. Mouawad takes a different stance.

“When amputation is on deck anyway, I always tell them, ‘Hey, look, if you’re willing to try and you’re ready to go through this, I’m willing to try for you so we can try this together,’” he explains. “And if for some unfortunate reason things don’t work out, then we’re back to where we were in the first place anyway. So I don’t think we lose anything.”

He emphasizes that while he doesn’t subject patients to futile procedures, even a small chance is better than none. “If there’s an opportunity—you know, a 10%, 20%, 30% chance—it’s better than zero. I would want somebody to try for me if I was willing to go through that myself.”

This approach doesn’t mean reckless intervention. Dr. Mouawad insists that patients must be partners in their care, especially those with advanced PAD, known as critical limb ischemia or critical limb-threatening ischemia (CLTI).

“This is atherosclerosis, a progressive disease,” he notes. “Particularly those that have critical limb ischemia or CLTI—they are going to lose the limb if you don’t do something about that. We know that the natural history of patients in end-stage PAD is critical limb ischemia, and something needs to be done.”

That “something” includes optimizing medical management, making patients part of the team, and having honest discussions about expectations. “I’m willing to try if you’re willing to try, but this won’t work with me alone or you alone. We have to work on this together.”

Walking as Medicine: The Ultimate Partnership

Being a true partner in care often means embracing what Dr. Mouawad considers the most powerful conservative treatment available: walking. For patients with intermittent claudication (leg pain while walking) who haven’t yet progressed to critical limb ischemia, a structured walking program can be transformative.

“When you have that pain in your leg, I want you to walk some more and force yourself to walk a little bit more,” he tells patients. “Because now your body is starting to develop these extra branches, which we call collaterals, to help restore blood flow to your legs.”

He emphasizes that while our instinct is to stop when we feel pain, with PAD-related claudication, pushing through (safely) is actually beneficial: “Believe me, if you had to have an operation done, we would do it, but you don’t want to have an operation. And if we can avoid it and get you back as close to the activity as you want, then we should maintain this conservatively.”

Dr. Mouawad has seen impressive results with this approach. “I can think of a few where I’m like, ‘Hey, look, we’re going to give you six weeks. I want you to force yourself to walk more, as much as you possibly can, and give yourself a shot.’”

When these patients return, most report significant improvement: “Lo and behold, most of them are like, ‘Doc, I feel like I’m able to do the things that I want to do.’”

He makes sure patients understand that while they may not “feel like they’re 20 again,” they can regain the ability to perform their daily activities. Importantly, these patients feel empowered because they played an active role in their own healing.

The Missing Diagnosis: When It’s Too Late for Walking Alone

As powerful as walking can be, it works best as an early intervention. Unfortunately, Dr. Mouawad routinely sees patients who’ve missed that critical window because their PAD went undiagnosed until it was advanced.

“The cases that keep me up at night are the people that think that nothing can be done for them. And so they don’t show up. And by the time they show up, it’s way too late,” he explains. “It’s very challenging because it’s like, ‘Hey, had you just made the phone call, you had asked somebody, gotten online, gone to a support group, this problem would have been much more simpler to solve three weeks ago, six weeks ago, a month ago than it is right now.’”

A concerning pattern he’s witnessed throughout his career is how frequently PAD goes undiagnosed while patients are treated for other conditions. He’s seen numerous cases where patients undergo orthopedic procedures, spinal surgeries, or have pain stimulators implanted when their symptoms actually stem from vascular issues.

“I could think of several where people have a significant amount of back pain, or it’s been relegated to sciatica or buttock or leg pain. It’s been going on for a while,” he explains. “There’s no formal vascular examination that happens.”

Often, a straightforward vascular evaluation would show an occluded vessel causing the symptoms. After addressing the blockage with a relatively simple procedure like angioplasty or stenting, symptoms that persisted through multiple other interventions completely resolve.

“Screening and, more importantly, awareness, particularly for lower extremity discomfort and pain, is critical for patients,” Dr. Mouawad emphasizes. “And if you’re not sure, ask, ask, ask.”

He’d rather see patients earlier than necessary than too late: “In my clinic, I’d rather see 100 normal cases that are seen ahead of schedule than to see one or two ones that should have been seen earlier.”

A Growing Public Health Crisis

This widespread problem of missed and delayed diagnoses is part of what Dr. Mouawad views as a broader public health crisis that requires urgent attention. The situation is only getting worse as our population ages.

“PAD is going to be more and more prevalent. And in fact, that’s a testament to our medical care. People are living longer because our medical care is better and better. But there are now diseases that are much more prevalent because they occur with age.”

He believes we need comprehensive strategies to address this growing challenge, including policy changes similar to those recently enacted in Illinois, which became the first state to require PAD testing for at-risk individuals.

“We’ve been very aggressive about that. We believe the way to move the needle is with policy,” he explains. “It’s also with engagement to the wonderful things that you and the organization is doing to increase awareness and education, not just for the patients only, but to other medical personnel and to the public as well.”

The solution must be multifaceted: “People need to be trained earlier from a medical perspective, but patients also need to be empowered to know that this is something that I want to prevent if at all possible, or be aware of it or screen for it early in an effort to avoid the long-term or late sequelae, which could result in amputation and a significantly decreased quality of life.”

The Power of a Second Opinion

For patients who are already facing advanced disease and potential amputation, Dr. Mouawad has one crucial piece of advice: don’t be afraid to seek a second opinion.

“Sometimes patients should have trust in their healthcare provider—it’s your most valuable asset, your health. But sometimes if you’re not comfortable with the plan of care, I think a lot of people are worried about saying, ‘Hey, look, I’m not sure about this. Can I have a second opinion?’”

He encourages patients to voice these concerns: “There’s nothing wrong with that. I think at the end of the day, you want to be comfortable with the ultimate decision and not regret it, particularly if it’s something that can’t be undone down the line.”

This circles back to his fundamental philosophy: sometimes all it takes is finding a physician who’s willing to try when others won’t. Even when interventions aren’t ultimately successful, patients who explore all options often feel more at peace with the outcome. They can say, “We checked this, we checked that. I feel like I’ve had an opportunity to ultimately come to the realization that there may not be something that we can do, but I feel like we weren’t rushed into it.”

WATCH THE FULL INTERVIEW WITH DR. NICOLAS MOUAWAD BELOW:

For clinicians interested in advanced PAD treatment approaches or establishing interdisciplinary PAD pathways, a great resource is ALPS (American Limb Preservation Society) .

For more information on the Global PAD Association and partnering in our efforts to provide education, high-touch advocacy, and real-time support for PAD patients globally, email info@PADhelp.org

Kym McNicholas is the Chairman & CEO of the Global PAD Association, a nonprofit organization dedicated to improving outcomes for patients with peripheral artery disease through education, advocacy, and research.