Angioplasty and Stenting
Angioplasty and stenting are performed by making a small incision in the skin above an artery in the arm or groin in order to access the artery. The physician then threads a balloon-tipped catheter from the incision site through the arterial system to the leg artery that is blocked or narrowed.
Once the balloon is positioned under the plaque, the physician inflates it to break up and compress the plaque and widen the blood vessel, improving blood flow through the artery. In some cases, the physician may then insert a stent, a small metal-mesh tube, to prop open the artery following angioplasty.
When angioplasty is successful, it has excellent results. Approximately 60 to 70 percent of patients who have an angioplasty have patent vessels, or vessels that remain open to provide adequate blood flow to the legs, 2 years after the procedure.
The initial failure rate for angioplasty in patients with leg artery disease is only about 10 percent. Failure may occur if the catheter is unable to move through the blockage or a weakened artery collapses after angioplasty and is impossible to keep open.
For more advanced forms of peripheral artery disease or critical limb ischemia, procedures that are more invasive than angioplasty, usually a surgical bypass graft or endarterectomy, may be needed.
Atherectomy
An atherectomy is a procedure that utilizes a catheter with a sharp blade on the end to remove plaque from a blood vessel. While the patient is under local anesthesia, the catheter is inserted into the artery through a small puncture in the artery.
The catheter is designed to collect the removed plaque in a chamber in the tip, which allows removal of the plaque as the device is removed from the artery. The process can be repeated at the time the treatment is performed to remove a significant amount of disease from the artery, thus eliminating a blockage from atherosclerotic disease.
Bypass Surgery
Surgical bypass treats narrowed arteries by creating a bypass around a section of the artery that is blocked. Arteries are normally smooth and unobstructed on the inside, but they can become blocked through a process called atherosclerosis, which means hardening of the arteries.
As you age, a sticky substance called plaque can build up in the walls of your arteries. Cholesterol, calcium, and fibrous tissue make up the plaque. As more plaque builds up, arteries can narrow and stiffen. Eventually, as the process progresses, blood vessels can no longer supply the oxygen demands of organs or muscles and symptoms may develop.
During a bypass, your vascular surgeon creates a new pathway for blood flow using a graft. A graft is a portion of one of your veins or a man-made synthetic tube that your surgeon connects above and below a blockage to allow blood to pass around it.
