Catheter-Based Treatment for Peripheral Artery Disease

Overview

If peripheral artery disease (PAD) causes the arteries in your legs to become clogged and narrowed to the point that blood flow can’t supply enough oxygen to your leg muscles, your doctor may recommend an endovascular procedure to restore blood flow to the muscles. An endovascular procedure is performed inside the blood vessels through the use of a small, flexible tube called a catheter. When blood flow is restored, leg pain—and the risk of losing a leg or foot due to severe narrowing of the arteries—may be reduced.

There are many endovascular procedures that may be recommended for the treatment of PAD, but the most common is angioplasty and stenting. This procedure is also commonly used to treat blocked arteries to the heart to restore blood flow and stop chest pain (angina), halt a heart attack, or lower the risk of a heart attack or stroke. An endovascular procedure is performed by a doctor who has had special endovascular training. PAD can be treated by a number of specialists, including interventional cardiologists, vascular surgeons, interventional radiologists, and vascular medicine specialists.

Peripheral angioplasty

A peripheral angioplasty is a procedure performed in the catheterization laboratory, or “cath lab,” in a hospital. The procedure involves the following steps:

1. You’ll lie on a table and be mildly sedated to help you relax, but you’ll remain awake throughout the procedure.
2. A catheter will be inserted into the artery and threaded through the arteries to the blockage. (Since there are no nerves in your arteries, you won’t feel the catheter.)
3. An X-ray camera and images of your arteries (shown on a television screen in the cath lab) will help your doctor guide the catheter to the blockage.
4. A tiny, thin wire will then be passed across the narrowed segment of the artery. It serves as a support for positioning the tiny balloon across the blockage.
5. Next, a balloon catheter—a long, thin flexible tube with a small uninflated balloon at its tip—will be threaded into the artery to where the artery is narrowed. Once in position, the balloon will be inflated to open up the artery.
6. In most cases, a tiny metal-mesh tube called a stent will be placed to hold the artery open and reduce the risk of the artery narrowing again. After the placement of the stent, your doctor will remove all of the catheters.

After your procedure

Most patients with PAD who are treated with angioplasty and stenting are released from the hospital 12 to 24 hours after the catheter is removed. Many patients are able to return to work within a few days to a week after a procedure. If your interventional procedure included insertion of a stent, your interventional cardiologist or other vascular specialist will provide prescriptions for blood-thinning drugs, such as aspirin and clopidogrel (Plavix), typically for a month to a year. It’s very important that you follow your doctor’s instructions and take your medications as your doctor prescribed. Even after you begin to feel better, you should never stop taking your medications at any time without speaking with your interventional cardiologist.