What are the surgical/procedural treatment options for Peripheral Arterial Disease?

For advanced PAD that causes severe pain or interferes with daily activities, a revascularisation procedure may be required to restore blood flow to the legs. This can be done through either endovascular (minimally invasive) procedures or surgery.

There are 2 main types of revascularisation treatments:

Angioplasty with or without stent placement

A thin tube (catheter) is inserted into the narrowed artery through a small incision in the leg. Once the catheter reaches the narrowed site, a tiny balloon at its tip is inflated to flatten the plaque. This widens the artery and improves blood flow.3 In some cases, a small mesh tube (stent) may also be inserted to keep the artery open. This procedure is less invasive than bypass surgery and can often be performed under local anesthesia, typically as a day case or with an overnight hospital stay.

This treatment would be suitable for those with lifestyle-limiting disease such as long distance claudication that prevents them from having an acceptable walking distance and performing daily activities.

Bypass surgery

A section of healthy vein is taken from another part of the body and surgically grafted to create a new route for blood to flow around the blockage in the artery. In some cases, an artificial vessel may be used instead.

This operation usually requires general anaesthetic. It is reserved for those with chronic limb ischaemia, short-distance claudication that severely impacts daily life, or those experiencing night pain, rest pain, arterial ulcers, or gangrene. The results of bypass surgery are generally longer-lasting than those of angioplasty.

Regardless of whether revascularisation is performed through an endovascular technique or open surgery, long-term success depends on adherence to prescribed medications (e.g., antiplatelet therapy, cholesterol, and blood pressure medications) and quitting smoking.