Leg Revascularization

What is lower extremity revascularization?

Revascularization of the leg repairs your blood flow to treat narrowing and/or blockage in your leg arteries. Healthcare providers can use open surgery or endovascular (minimally invasive) procedures to accomplish this.

Types of leg revascularization

Healthcare providers can perform revascularization of your leg with:

• Angioplasty. Using a balloon to push plaque (fatty) buildup against your artery walls to open up the artery.
• Stents. Putting a small metal tube inside your artery to hold the artery open.
• Atherectomy. Using a device with a blade or laser to remove plaque.
• Bypass. Using one of your veins or an artificial graft to reroute blood flow around a blocked artery.
• Endarterectomy. Cutting into your artery and removing the plaque inside it.

What does leg revascularization treat?

People who have peripheral artery disease (PAD) may need a leg revascularization procedure. This is because the leg may not have enough blood flow or oxygen due to the disease. The symptoms and disease determine the treatment.

Smoking cessation, medications and walking programs are nonsurgical treatments for PAD. If symptoms are severe with constant pain or wounds, healthcare providers call that critical limb ischemia and it’s likely to need surgery.

What percentage of people have peripheral artery disease (PAD)?

Between 12% and 20% of Americans age 60 and older have PAD. Almost 50% of people older than 85 in the U.S. have it. In some people, this disease can lead to the need for lower extremity arterial revascularization. A multi-year study found that only about 20% of people admitted to the hospital with PAD needed revascularization.

How should I prepare for revascularization of the leg?

Your healthcare provider will consider and discuss the various types of leg revascularization with you. They’ll most likely want to try less invasive methods before performing surgery, if possible. However, the choice of revascularization method depends on:

• The severity of your disease.
• The location of your disease.
• The risks of general anesthesia and surgery.
• Other medical issues you have.

Before doing a lower limb revascularization, your provider will give you a physical exam and ask you about your medical history. They’ll also order tests, which may include:

• Lab tests.
• Ultrasound.
• Electrocardiogram (EKG).
• Computed tomography (CT) angiogram.
• Magnetic resonance angiogram.
• Stress test.
• Angiogram.

You’ll need to stop eating and drinking for several hours (likely after midnight) before your procedure. For better results, you should also stop using tobacco products. Your provider may tell you to stop taking certain medicines before your procedure. Only do this if your provider tells you to do so. Your provider will give you instructions on surgical bathing the night before your procedure.

What happens during leg revascularization?

The goal of each procedure is to improve blood flow to an area where your leg isn’t getting enough. Different methods treat the issue in different ways:

• For angioplasty, a healthcare provider will put a catheter through your skin and into a blood vessel. They usually start at your arm or groin. When they get the catheter to the problem area, they use a balloon to push the plaque against your artery walls to open up the artery. A provider may put in a stent, or small metal tube, to hold your artery open long-term.
• In atherectomy, a provider uses a catheter with a blade or laser on the end to shave plaque off inside your artery. This helps open up the artery and improve blood flow through it.
• An endarterectomy is similar to an atherectomy, but a provider makes a cut right over your artery instead of using a catheter to reach it. This is a more invasive procedure.
• In bypass surgery, a surgeon will take a blood vessel from elsewhere in your body or use an artificial graft. They’ll sew it above and below the blocked artery so your blood can flow around (bypass) the blockage.

How long does revascularization of the leg take?

Revascularization of your lower extremities takes different amounts of time, depending on which procedure you have. Angioplasty may take from 30 minutes to several hours. Atherectomy may take a few hours. A bypass for leg revascularization can take two to six hours.

What happens after leg revascularization?

After any procedure, you’ll need to lie down for a while. It may be several hours, depending on the procedure. Healthcare providers will monitor you and give you any medicines you need.

A healthcare provider will need to do tests to make sure your arteries don’t have problems with blood flow again. These may include:

• Ankle-brachial index.
• Ultrasound.
• Computed tomography (CT) angiogram.
• Magnetic resonance angiogram.

What are the benefits of revascularization of the leg?

Leg revascularization provides these benefits:

• Improves symptoms.
• Improves quality of life.
• Helps you avoid the need for a leg amputation.

How successful is leg revascularization?

In people who get leg revascularization, 70% are still alive two years after treatment. In 75% of people who have certain bypass surgeries, their new bypass route can stay open for 10 years.

With angioplasty, larger blood vessels stay open longer than smaller ones, with or without a stent.

You may need a repeat procedure after open or minimally invasive (endovascular) procedures. However, people who get the minimally invasive option may be more likely to need another procedure in the future.

You can help the results of your leg revascularization last longer by:

• Quitting tobacco products.
• Taking cholesterol-lowering medicines (if your provider prescribes them).
• Taking medicines that protect your heart health (if your provider prescribes them).
• Walking daily.

What are the risks or complications of revascularization of the leg?

After leg revascularization, complications may include:

• Cardiac events.
• Bleeding.
• Issues with a wound from your procedure, including infection.
• Blood clots after angioplasty or in a graft from a bypass procedure.
• Graft infections from a bypass procedure.
• Symptoms of a blockage coming back.
• Kidney failure after a bypass.
• Damage to a blood vessel from an endovascular procedure.
• A stent getting out of place.
• Plaque coming loose and traveling to another blood vessel.
• Death.

What is the recovery time?

After an angioplasty with or without a stent placement and atherectomy, you’ll need about a week to recover. You may need an overnight stay in the hospital.

For an endarterectomy, you may spend two to four days in the hospital.

You can expect to spend two to five days in the hospital after a bypass surgery, and then spend six to eight weeks recovering.

When can I go back to work/school?

After an angioplasty, you can return to work or school a week later. You may need to wait several weeks before going back after an endarterectomy or a bypass procedure.

When should I call my healthcare provider?

You’ll have follow-up appointments with your provider after your procedure. However, you should contact your provider if you have:

• An infection.
• Bleeding.
• Warmth or pain at your wound site.
• Swelling.
• Fever.
• Chills.
• Chest pain.
• Numbness in the leg or difficulty moving the leg that had the procedure.

A note from Cleveland Clinic

Peripheral artery disease causes uncomfortable symptoms that can get in the way of your everyday life. Revascularization of your leg can help you feel better and improve your quality of life. Your healthcare provider can talk with you about which leg revascularization procedure may work best for you. You should feel comfortable asking questions about how procedures work and what you’ll experience. Understanding your procedure helps you feel more at ease because you know what to expect.