Revascularization is a procedure that can restore blood flow in blocked arteries or veins. For someone with peripheral artery disease (PAD), the operation can help ease symptoms and prevent serious complications.
The goals are to relieve pain, help you stay active, heal wounds related to lack of blood flow, save your limbs from amputation, and improve your day-to-day life.
What Conditions Does Revascularization Treat?
People with arteries that are so blocked that blood can’t travel to their legs and feet may benefit from a revascularization procedure. But it’s not for everyone. Whether it’s right for you depends on how bad your PAD symptoms are.
For example, a less severe form of PAD is called intermittent claudication, which involves leg pain during exercise that disappears when you rest. The first treatment is usually a rehabilitation program that involves physical activity. A doctor may also prescribe medicine and recommend you quit smoking before they consider revascularization if needed.
Ischemia -- where the lack of blood flow has badly damaged leg and/or foot tissue -- is more severe and requires prompt care. Its symptoms can include pain, ulcers, or gangrene. Without revascularization, you may lose all or part of your limb to amputation.
What Are Different Types of Revascularization Procedures?
Revascularization falls into two main categories: less-invasive interventional procedures and more-traditional surgeries.
There are two main types of interventional procedures, which usually happen while you’re still awake but with medicine to keep you comfortable.
Angioplasty: Your doctor uses a small balloon to open a blocked blood vessel. They start by making a small cut in your groin and inserting a catheter into an artery in your leg. Within the catheter, they then place a small balloon into the narrowed blood vessel and expand it.
Some people get a stent during angioplasty to help keep a blood vessel open after the balloon has been removed. Stents are metal mesh tubes that provide support inside the blood vessel. Some types release drugs over time to keep a blood vessel from narrowing again.
Atherectomy: Your doctor uses a catheter with a sharp tool attached to physically clear out the plaque that’s creating the blockage. It’s an option for blocked arteries in areas that are hard to reach with stents.
Some people need revascularization surgery, which happens under general anesthesia (when you get medicine to put you to sleep). There are two main types:
Bypass surgery: A vascular surgeon uses a graft of a blood vessel to reroute blood flow around a blockage.
Endarterectomy: A surgeon opens your artery to remove plaque buildup inside.
In some cases, doctors use a hybrid procedure that combines both a catheter-based intervention and open surgery.
Are There Complications of Revascularization?
As with any medical procedure, complications can happen with revascularization. You may be more likely to have complications if you have other diseases beyond your PAD, such as coronary artery disease, chronic kidney disease, and diabetes. Restenosis, calcification, microvascular disease, silent embolization can all occur after a revascularization procedure.
With interventional treatments, you can have problems where your doctor inserts the catheter, especially bleeding. Rarely, it’s possible to develop a clot that blocks blood flow from the heart to your limb, or to have too much blood flowing to your limb after the procedure.
Complications after bypass surgery or endarterectomy are rare, but they can include:
- Injury to the blood vessel
- Mild leg swelling
- Problems at the wound site
- Re-blockage of the artery
Your doctor will keep a close eye on your after your procedure to be sure you’re healing well and the procedure remains successful.
How Fast Will I Recover After Revascularization?
With surgery, most people spend several nights in the hospital, possibly up to a week. You may feel a little tired for a few weeks, and have mild pain around your incisions and some leg swelling. As time passes, you can probably return to normal activities, but be sure to follow your doctor’s specific guidelines for recovery.
With an interventional procedure, recovery time is likely to be shorter. You may go home the same day of angioplasty or stent placement. At first you may notice your legs are swollen or your groin is a bit sore where your doctor inserted the catheter. Soon you may find you can walk farther than before your procedure.
After an atherectomy, you may be back to normal activities within a week. Again, be sure to ask your doctor for instructions. If you’ve received a stent, for instance, you may need to take medicines to prevent clotting around the device.
What to Ask Your Doctor
- What can I do myself to make my PAD symptoms less severe?
- Are there other treatment options I should try before revascularization?
- What will likely happen if I don’t have revascularization?
- How do you know when it’s time for this procedure?
- What are the risks?
- Afterward, how can I help keep my PAD under control?
- What sort of follow-up visits will I need and when?
- How likely is it I’ll need to have another revascularization again in the future?