Surgery

Surgery

In severe cases, surgery may be needed to open blocked blood vessels. Some evidence suggests that surgical procedures are better for patients with blockages above the knee, and that more conservative measures might be just as effective for blockage below the knee.

Leg Bypass Surgery

For years, leg bypass surgery has been the main type of surgery used for extensive PAD. This procedure involves the creation of a tube (graft) that acts as a new blood vessel. Grafts can be made from synthetic material (artificial vein) or from a vein taken from a different location in the patient's leg (natural vein). The graft reroutes blood flow in the leg, around the blocked artery. In one study, the natural vein remained open after 4 years in nearly half of the patients, while the synthetic vein (made from polytetrafluoroethylene [PTFE]) had closed in all but 12% of patients.

Artificial veins tend to pose a much a higher risk for blood clots and the consequences of re-blockage are must more severe than when the natural vein recloses. To keep the artificial vein open, oral anti-clotting drugs such as aspirin or warfarin, may be used. (Such drugs do not work at all with natural vein bypass.)

Percutaneous Transluminal Angioplasty

Percutaneous transluminal angioplasty (PTA) is an approach that has several variations. The object of the procedure is to open the blocked blood vessels that are causing intermittent claudication. Angioplasty is being increasingly used, especially in patients who have other medical conditions. Some experts believe that it is less expensive and more effective than leg bypass surgery.

The PTA procedure requires only a local anesthetic. Patients can return to normal activity in 24 to 48 hours. Complication rates are low. The effects are not permanent, but it the procedure can be repeated without any greater risk than with the original one.

Anticoagulants such as warfarin or heparin and antiplatelets such as aspirin may used to prevent blood clots occurring during surgery. All of these drugs increase the risk for bleeding. Thrombolytic drugs may be used before, during, or after angioplasty if a blood clot is present.