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The surgical approach to vascular disease is intended to either open up diseased arteries or to bypass them with new ones. An open surgical procedure ( bypass grafting ) is the traditional approach.

Less invasive techniques, such as percutaneous angioplasty , use long, thin instruments that are passed through blood vessels.

Bypass Grafting

If blood flow to your limb is blocked or nearly blocked, you may the doctor may recommend bypass grafting. A graft is attached above and below the blocked artery. This graft provides a clear path for the blood to flow around the blockage. The graft may be made from a vein from another part of your body, such as a leg, or from man-made material.

Percutaneous Angioplasty

This procedure allows doctors to approach your diseased arteries from the inside via real time x-rays and high-tech instruments. These instruments can be passed through your blood vessels. Starting with an easily accessed artery, most likely in the groin, the doctor will thread long, thin instruments into the vessel under x-ray guidance until it reaches the problem area. There, several possible techniques can be used to open up the diseased or clogged part of the artery.

Once the instruments have reached the target site, the doctor may elect to insert a tapered dilator or balloon into the narrowing to stretch it out. Alternatives include injecting clot dissolving chemicals directly into the blocked artery or removing a clot with special instruments. A rigid stent may be inserted to keep the artery open.

Balloon Angioplasty


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Cryoplasty

Cryoplasty is similar to angioplasty. However, when the balloon reaches the blockage, it is filled with nitrous oxide, which cools and opens the artery.

References:

How is peripheral arterial disease treated? National Heart, Lung, and Blood Institute website. Available at: http://www.nhlbi.nih.gov/health/health-topics/topics/pad/treatment.html . Updated April 1, 2011. Accessed August 8, 2013.

Peripheral arterial disease (PAD) of lower extremities. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed.ebscohost.com/about/about-us . Updated August 3, 2013. Accessed August 8, 2013.

Prevention and treatment of PAD. American Heart Association website. Available at: http://www.heart.org/HEARTORG/Conditions/More/PeripheralArteryDisease/Prevention-and-Treatment-of-PAD_UCM_301308_Article.jsp . Updated November 20, 2012. Accessed August 8, 2013.

11/4/2013 DynaMed's Systematic Literature Surveillance. Available at: http://dynamed.ebscohost.com/about/about-us: McCaslin JE, Andras A, et al. Cryoplasty for peripheral arterial disease. Cochrane Database Syst Rev. 2013 Aug 11;8.



Last reviewed August 2013 by Michael J. Fucci, DO; Brian Randall, MD

Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.

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