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Surgical Treatment Options

(Also Called 'Peripheral Artery Disease (PAD) Surgery')

Atherosclerosis is usually controllable with treatment, but recurrences can occur. Restoring blood flow with a vascular procedure provides good relief of symptoms, although as with the treatment of any significant disease, complications may occur.

In some situations, the blockage in the arteries to the leg have progressed to the point that there is severe reduction in the blood flow to the foot. This can be extensive enough to put the foot at risk of amputation. This extreme variant of PAD is referred to as critical limb ischemia (CLI) and it is often imperative in this situation to restore blood flow to the foot with a vascular procedure.

Balloon angioplasty: (Percutaneous Transluminal Angioplasty or PTA)

A balloon angioplasty is a procedure in which a small balloon at the tip of the catheter is inserted through the blocked or narrowed area of the artery. The balloon, which inflates to a predetermined diameter, is inflated to dilate the artery and push the plaque back to open the diseased blood vessel. The technical name for this procedure is percutaneous transluminal angioplasty (PTA). When the balloon is inflated, the fatty plaque or blockage is compressed against the artery walls and the diameter of the blood vessel is widened (dilated) to increase blood flow to the leg.

Balloon Angioplasty and Stenting

In some cases, balloon angioplasty is performed in combination with a stenting procedure. A stent is a small, metal mesh tube that acts as a scaffold to provide support inside the artery. A catheter, placed over a guide wire, is used to insert the stent into the narrowed artery. Once in place, the stent is deployed and expands to the size of the artery and holds it open. A balloon may be used to insert the stent or the stent may have an outward force itself that allows it to expand on its own. If a balloon is used to deliver and deploy or expand the stent, it is deflated and removed, and the stent stays in place permanently. During a period of several weeks, the artery heals around the stent.

A note about drug eluting stents (DES): There are currently no drug-eluting stents that are approved for use in the peripheral arteries, although research is under way. Drug-eluting stents contain a thin surface of medication that is actively released at the stent implantation site to reduce the risk of restenosis. These types of stents are currently only used in coronary arteries.

Cutting Balloon

The cutting balloon catheter has a balloon tip with small blades. When the balloon is inflated, the blades are activated. The small blades score the plaque, then, the balloon compresses the fatty matter into the arterial wall. This type of balloon may be used to treat the build up of plaque within a previously placed stent (restenosis) or other special types of blockages.

Atherectomy

Atherectomy is a procedure that utilizes a catheter with a sharp blade to remove plaque from a blood vessel. The catheter is designed to collect the removed plaque in a chamber in the tip of the catheter, 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. It is especially helpful for treating blockages in arteries that occur around branches or in vessels that are not easily treated with stents.

Thrombolysis

Thrombolytic therapy uses drugs designed to dissolve clots and restore normal blood flow. Your physician will inject a clot-dissolving medication into a blood vessel. A catheter (a long, thin tube) may also be used to deliver the medication or to break up the clot.

Surgical Bypass

A surgical bypass reroutes blood flow around the blood vessel blockage by creating a new pathway for blood flow using a graft. To bypass the blockage, the surgeon makes a small opening just below the blockage in the diseased artery and places a graft, which is either a portion of one of your veins or a man-made synthetic tube. The surgeon will connect the graft above and below a blockage to allow blood around the blockage.

Endarterectomy

Open surgical removal of cholesterol plaque from an artery, also known as endarterectomy, may be performed to surgically remove the blockage. The surgeon will make an incision in the affected artery and remove the plaque contained in the artery's inner lining restore blood flow.

Amputation

In extreme cases when circulation is severely reduced and cannot be improved by the methods already discussed, your surgeon may recommend amputating your lower leg or foot. Our surgeons see a large number of patients who have been recommended for amputation, but have been able to avoid this loss of limb in a majority of patients. Seeking a second opinion at the Cleveland Clinic after your surgeon has recommended an amputation can assure you that you have been provided every opportunity to save your limb. Not all patients, however, can have the severe results of extended lack of blood flow reversed, and amputation becomes a treatment of last resort; more than 90 percent of patients can avoid amputation or have it limited to a small portion of the foot or toes.

Outcomes for Atherosclerosis Treatment at Cleveland Clinic

Vascular surgeons at Cleveland Clinic have extensive experience with surgical treatments of atherosclerosis. They have the ability to utilize a wide array of techniques to restore blood flow to the limb tailored to the individual patient. Go here for information about research and clinical trials.


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