Surgery for Lower Extremity Arterial Disease

Most people with lower extremity arterial disease are treated successfully at NYU Langone with atherectomy. The procedure involves clearing a clogged artery by shaving, cutting, or vaporizing plaque, a waxy substance composed of fat, cholesterol, calcium, and other materials in the blood.

Before the procedure begins, you receive a local anesthetic, plus a mild sedative. You may also receive an injection of contrast dye, which allows the doctor to view the blockage on an X-ray. The surgeon then inserts a catheter, a thin tube, into the groin above the femoral artery—the major artery that brings blood to the leg. The surgeon guides the catheter to the blocked artery and removes the plaque using a tool attached to the tip of the catheter.

The surgeon may then perform other procedures, such as balloon angioplasty and stenting, which help prevent future blockages. The procedure is performed in the hospital. Most people can go home the same day.

Atherectomy is often, but not always, immediately followed by a balloon angioplasty and the insertion of a stent, a metal mesh tube that is inserted into a blood vessel to hold it open. Balloon angioplasty is also a minimally invasive procedure performed using a local anesthetic. 

During balloon angioplasty, the doctor inflates a surgical balloon and pushes it through the catheter and into the blood vessel. Afterward, he or she may place a stent in the vessel. This enables it to heal after the procedure and improves blood flow. The surgeon removes the balloon but leaves the stent in place permanently. The procedure lasts 30 to 90 minutes, depending on how severe the blockage is.

If you do not have an atherectomy before angioplasty and stenting, you may be able to go home the day of the procedure. If you have atherectomy first, you may have to stay in the hospital overnight. You can typically resume everyday activities within two days.

Balloon angioplasty and stenting may not be the best treatment for people with advanced arterial blockages and other health problems, such as intermittent claudication, or pain when walking; gangrene, or tissue death, often due to diabetes; open sores on the leg; or a pulmonary embolism, a blood clot in the leg that breaks loose and travels through the bloodstream to a lung artery, creating a potentially life-threatening blockage. 

Instead, NYU Langone doctors may recommend a leg bypass. This procedure allows the surgeon to create a new route for blood to travel around the blocked artery, restoring blood flow to the leg. The greatest benefit of bypass surgery is that it can save a leg that would otherwise need to be amputated because of gangrene. 

During a leg bypass, a surgeon makes an incision into the skin of the leg and selects and removes a healthy vein to serve as a bypass graft for the blocked artery. Next, the surgeon makes an incision near the blocked portion of the artery. The surgeon opens the artery below the blockage and connects one end of the vein graft with permanent stitches. Then he or she directs the graft to a location above the blockage, opens the artery, and connects the other end with permanent stitches. 

Doppler ultrasound, in which high-frequency sound waves are used to create images inside the body, is then used to evaluate blood flow in the artery to ensure the bypass is functioning properly.

A leg bypass procedure may be performed under general or regional anesthesia. Your doctor recommends which type is most appropriate for you based on your medical history. After surgery, you can expect to recover in the hospital for three to 10 days. Stitches are removed one to two weeks after surgery. During this time, your surgeon may prescribe a medication to prevent blood clots from forming around the bypass.

Complications from bypass surgery can occur. Having an experienced vascular surgeon greatly reduces your risk of having a complication. Contact your physician immediately if you develop fever, coldness or pain in your leg, redness, swelling, or any type of drainage from the incision.