Vascular surgery for PAD is an important option to treat patients with advanced vascular disease. For patients who have failed at improvement with lifestyle changes and medication, these procedures will restore circulation, and reduce complications of PAD.
An atherectomy is a procedure to remove plaques in the diseases arteries. Atherectomy devices are designed to shave or vaporize these plaques to clear the arteries, and remove blood clots to improve circulation to the legs and feet. The location of the pain depends on the vessels involved and the severity of the blockages.
A laser atherectomy is a minimally invasive treatment for management of patients with PAD. Precise, intense laser light energy is targeted to the blockage to eliminate dangerous plaques that cause PAD, without damaging the surrounding tissue. A small fiber-optic catheter connected to the laser, is inserted through the femoral artery (the blood vessel that delivers blood to the thighs, leg and feet) in the groin. The catheter is slowly moved through the artery. When it reaches the blockage, it dissolves the clog and restores blood blow. The results are dramatic. Within a few days after this procedure, you will be able walk pain free. A laser atherectomy may be combined with a balloon-angioplasty.
Angioplasty for PAD is called percutaneous transluminal angioplasty or PTA. Here a thin catheter, with a small balloon at the tip, is inserted into the femoral artery in your groin and guided to the blockage. When it reaches the blockage, the balloon is inflated. The pressure from the balloon compresses the blockage against the artery wall, to restore blood flow and relieve intermittent claudication. The size of the vessel, the length of the occlusion and the extent of blockage determine whether angioplasty is the appropriate treatment choice. You may receive additional testing.
In addition to balloon angioplasty, a stent (a small metal mesh tube) is used to keep an artery open. The stent is left in place, and the balloon and all the wires are then removed.
A surgical bypass reroutes blood flow around the blockage to restore blood flow to the leg. Under general anesthetic, a natural or synthetic graft is used to create a detour around the blockage. A natural graft can be made from your own veins. A synthetic graft can be made from fabric or plastic. The graft is sewn to the affected artery above and below the blockage. This is a hospital procedure and you may be in the hospital for 2-5 days for monitoring and to recuperate. You may need a few weeks off of work to recover before driving or doing heavy work. Muscle pain will resolve. There is a risk that the bypass graft will become blocked. Other surgery can remedy this problem.
When the femoral artery is clogged due to atherosclerosis, the procedure to clean out the femoral artery is called an endarterectomy. A 2-4 inch incision in the groin above the femoral artery is made. The femoral artery will be clamped above and below the blockage. This stops blood flow in the area. The artery is cut open and the plaque is stripped away. Then the artery is closed and blood flow restored. You may receive angiography during the surgery to help your surgeon determine the length of the blockage, and when the blockage is gone. It is a short, and fairly low risk procedure performed in a hospital.
We understand that that considering surgery is a frightening thing. We are here to help you. We will explain all the information you need to know to make an informed decision. At South Valley Vascular in Visala, Porterville and Hanford, CA we are committed to your care.
Need more information on Peripheral Arterial Disease? Visit the Society for Vascular Surgery Patient Resources section here.