Leg revascularization

Overview

Leg revascularization treats leg artery narrowing and/or blockage by restoring blood flow. To do this, medical professionals can employ endovascular (minimally invasive) or open surgery.

Types of leg revascularization

Your leg can be revascularized by doctors using:

• Stents. Introducing a tiny metal tube to maintain the artery open.
• Angioplasty. Opening up your artery by using a balloon to force plaque (fatty buildup) against the walls.
• Bypass. Rerouting blood flow around a blocked artery using an artificial graft or one of your veins.
• Atherectomy. Using a laser or blade device, remove plaque.
• Endarterectomy. Making a cut into your artery and removing the plaque from within.

Reasons for undergoing the procedure

Individuals with Peripheral Artery Disease (PAD) can require a leg revascularization operation. This is because the condition may not be allowing enough blood or oxygen to reach the leg. The disease and its symptoms dictate the course of treatment.

The nonsurgical treatments for PAD include medicine, walking programs, and quitting smoking. Doctors refer to severe symptoms such as persistent pain or sores as critical limb ischemia, which usually requires surgery.

Risks

Following revascularization of the leg, complications could include:

• Bleeding.
• Cardiac events
• Graft infections resulting from a bypass procedure.
• Problems with your procedure-related wound, such as infections.
• Symptoms of a recurring obstruction.
• Kidney failure following a bypass procedure.
• A blood vessel that has been damaged during an endovascular operation.
• Blood clots in a bypass operation graft or following angioplasty.
• A stent that is shifting location.
• A loose plaque that moves to a different blood vessel.
• Mortality.

Before the procedure

Your doctor will evaluate and go over the different kinds of leg revascularization with you. If at all possible, they’ll probably want to attempt less invasive techniques before doing surgery. The selection of the revascularization technique is contingent upon:

• The affected location
• How severe the disease is
• Other underlying medical disorder
• General anesthesia and surgical risks

Your doctor will perform a physical examination and inquire about your medical history prior to performing a lower limb revascularization. They will also request tests, which could consist of:

• Lab tests
• Ultrasound
• Electrocardiogram (EKG)
• Computed Tomography (CT) angiogram
• Magnetic Resonance Angiogram (MRA)
• Stress test
• Angiogram

Before your procedure, you will need to fast for hours (probably after midnight). To achieve improved outcomes, it is advisable to discontinue the use of tobacco products. Before your treatment, your doctor could advise you to cease using a specific medication. You should only take this action at your provider’s request. The night before your treatment, you will get instructions on surgical bathing from your provider.

During the procedure

Each surgery aims to increase blood flow to a leg location that isn’t receiving enough of it. Various approaches address the problem through diverse methods:

• Angioplasty. A doctor will put a catheter through your skin and into a blood vessel. They usually start at your arm or groin. A balloon forces the plaque against your artery’s walls once the catheter is in the problematic area, opening the artery. A stent, a thin metal tube, may be inserted by a medical practitioner to keep your artery open over time.
• Atherectomy. A doctor removes plaque from your artery by using a catheter that has a blade or laser on the end. This facilitates arterial opening and enhances blood flow via it.
• Endarterectomy. Comparable to an atherectomy, except instead of utilizing a catheter to access your artery, the doctor makes a cut directly over it. This process is more intrusive.
• Bypass surgery. A blood vessel from another part of your body or an artificial graft will be used by the surgeon. To allow your blood to flow around (bypass) the blockage, they will suture it both above and below the blocked artery.

The length of time it takes to revascularize your lower extremities varies according on the method you choose. Angioplasty times might range from thirty minutes to many hours. An atherectomy could require few hours. Leg revascularization can be accomplished with a bypass in two to six hours.

After the procedure

You will need to lie down for a bit following any operation. Several hours could pass, depending on the operation. Your doctor will keep an eye on you and administer any necessary medication.

Tests performed by a medical professional are necessary to ensure that your arteries are not experiencing blood flow issues once more. They could consist of:

• Ankle-brachial index
• Ultrasound
• Computed Tomography (CT) angiogram
• Magnetic Resonance Angiogram (MRA)

Outcome

You’ll need roughly a week to recover following an angioplasty, with or without stent implantation and atherectomy. You might have to spend the night in the hospital.

You might stay in the hospital for two to four days following an endarterectomy.

After a bypass procedure, you should plan to stay in the hospital for two to five days and then recuperate for six to eight weeks.

After undergoing an angioplasty, it is generally possible to resume work or school within a week. However, if you’ve had an endarterectomy or a bypass procedure, you may need to wait several weeks before returning to your regular routine.

In the case of leg revascularization, approximately 70% of individuals remain alive two years post-treatment. For certain bypass surgeries, about 75% of people experience a successful outcome with their new bypass route staying open for up to 10 years.

When it comes to angioplasty, the durability of larger blood vessels tends to exceed that of smaller ones, whether or not a stent is used. In some cases, you may require a repeat procedure after undergoing open or minimally invasive (endovascular) treatments. It’s worth noting that individuals who opt for the minimally invasive approach may have a higher likelihood of requiring additional procedures in the future.

To enhance the longevity of the results from your leg revascularization, consider the following:

• Quitting tobacco products.
• Adhering to prescribed cholesterol-lowering medications.
• Taking medications that safeguard your heart health as recommended by your healthcare provider.
• Engaging in daily walking.