When Is Surgery Used in Peripheral Artery Disease?

Sometimes you can treat a health problem with a change in diet or the right medicine. Other times, these are helpful, but you still need more.

When you have a really tough case of peripheral artery disease, or PAD, you might need surgery as well.

A Sticky Mix in the Arteries

With PAD, you have plaque build-up in your arteries, the vessels that carry blood from the heart to the rest of your body. The build-up is usually in your legs, but may be in arteries that go to your arms, head, stomach, or kidneys, too. Plaque is a sticky mix of cholesterol, fat, calcium and other substances. This condition might cause leg pain when you exercise, and it can lead to a heart attack or stroke.

If medicine and lifestyle changes haven’t done enough for your PAD, your doctor might suggest one of these things:

  • Angioplasty to widen the artery and let more blood flow through and a stent, or small mesh tube, to help keep the artery open
  • Atherectomy to remove plaque
  • Bypass surgery to send blood around the blockage

Angioplasty and atherectomy aren’t full-blown surgeries. You aren’t given anything to make you sleep during the procedure, and often, you get out of the hospital within 24 hours. But these treatments don’t work for everyone. That’s when you might need bypass surgery.

If you want to be successful in the long term with any of these treatments, stick to healthy lifestyle changes, too. If you’re a smoker, quitting makes it more likely that these treatments will work.

Angioplasty

Angioplasty widens the artery where you have a blockage. Your doctor places a thin, flexible tube, called a catheter, into your artery. The end of the catheter holds a small balloon that doesn’t have air in it.

She slides the tube into place so that the balloon sits right at the blockage. When it fills with air, it breaks up the plaque so your blood can flow more normally.

During the procedure, your doctor may also put in a stent, a small mesh tube that keeps the artery open wide. Some have medicine on them to help keep more build-ups from happening.

Angioplasty takes 1 to 3 hours. You’ll be awake for it, but you’ll get medicine to keep you calm and make sure you don’t feel any pain. You usually stay in the hospital less than 24 hours.

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Atherectomy

This takes out the plaque build-up from your artery. It may be used along with angioplasty to take out hard blockages before the balloon is blown up. It may also be used when angioplasty isn’t possible. This could be because of where the blockage is or because the plaque is too hard.

The doctor also uses a catheter in this procedure. Instead of a balloon on the end, there’s a tiny tool that removes plaque. The tool might be a sharp blade, a grinder, or a laser. As with angioplasty, your doctor may place a stent in your artery to help keep it open.

An atherectomy takes about 2 hours. You’ll be awake, but your doctor will give you medicine to keep you calm and make sure you’re not in pain. Usually, you stay in the hospital 1 to 2 days.

Bypass Surgery

Your doctor may try an angioplasty first, but if you have a very large blockage, you might need the bypass.

This gives your blood a different path to flow through, so it goes around the blockage. It’s like taking a detour around a construction site on a highway. To make this new path, your surgeon may use a vein from another part of your body. Or she might use a special tube made from fabric or plastic.

She attaches one end of the vein or tube to your artery before the blockage and the other end after the blockage. Your blood can now bypass the blockage and flow where it’s needed.

This surgery takes 2 to 5 hours, and you won’t be awake for it. You usually stay in the hospital for 3 to 7 days. When you go home, make sure you understand all the  instructions your doctor has given you.

 

WebMD Medical Reference Reviewed by Suzanne R. Steinbaum, MD on August 22, 2016

Sources

SOURCES:

American Heart Association: “Prevention and Treatment of PAD.”

NIH, National Heart, Lung, and Blood Institute, “Explore Peripheral Artery Disease.”

Harvard Health Publications, Harvard Medical School: “Peripheral Artery Disease.”

Keck School of Medicine of the University of Southern California, Department of Surgery: “Leg Pain and Peripheral Artery Disease (PAD).”

Cleveland Clinic: “PAD: Atherectomy.”

University of California at San Diego Health: “Sample Consultation for Peripheral Artery Disease.”

University of Michigan Health System, Department of Surgery: “Atherectomy.”

University of California, San Francisco Department of Surgery, Division of Vascular and Endovascular Surgery: “Lower Extremity Bypass Surgery.”

Society for Vascular Surgery: “Bypass Surgery.”

 

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