Procedures for Peripheral Vascular Disease
If you have severe lifestyle-limiting claudication (ie, your leg pain interferes with your ability to carry out daily activities successfully), particularly if medication has been unsuccessful in relieving symptoms, your doctor may recommend a procedure to increase the amount of blood flow to your legs.
Revascularization procedures can be generally divided into two general categories: “catheter-based” endovascular procedures, which are done without incisions (eg, balloon angioplasty with or without stenting, atherectomy, recanalization), and “surgery” (eg, bypass, endarterectomy).
Increasingly, revascularization may involve a combination of multiple techniques and devices, called “hybrid” procedures, all with the objective of improving blood flow.
The selection of revascularization technique depends upon a variety of factors, such as your particular anatomy, severity of symptoms, prior interventions, suitability for anesthesia, and the experience of your physician, as well as your personal preferences. There is no one single revascularization procedure for claudication.
Endovascular — Endovascular intervention (without incisions) is generally attempted before surgery since it is less invasive and has fewer cardiovascular risks. Endovascular procedures are performed through a catheter (thin tube) placed into the femoral artery through the skin in the groin region. Balloon angioplasty involves threading a guidewire through the narrowed or blocked vessel. A deflated balloon is placed over the wire, and the balloon is inflated and then deflated. This opens the vessel and allows blood to flow more freely.
A stent is often used to hold the vessel open after angioplasty. A stent is an expandable tube made of a wire mesh. The goal of a stent is to prevent restenosis, which is when the vessel becomes narrowed again. Stents work better in some vessels compared with others. “Drug-eluting” balloons and stents are sometimes used; these release medication to help the vessel stay open longer.
Angioplasty and stenting are most successful for treating single, short blockages, but advancements in technology have allowed treatment of multiple, longer, and even completely blocked artery segments. However, restenosis is more common when longer or blocked segments are treated.
Atherectomy uses a specialized device to remove the plaque that is causing the blockage by cutting or burning it. Another technique uses a special catheter to open up completely blocked vessels.
Surgery — Surgical revascularization involves sewing in a graft (usually a vein, but sometimes man-made material) to go around (bypass) the narrowed or blocked area of the blood vessel, which improves blood flow to the rest of the leg. The best candidates for surgery are those who are younger, do not have diabetes, and have little disease in the vessels below the knee. Many older individuals and those with diabetes are able to have successful surgery, but it is important for these patients to understand that they have a higher risk for postoperative complications.