Surgery related to peripheral artery disease is a minimally-invasive procedure that helps reroute the blood flow around your blocked artery. This problem typically arises in your legs, or lower extremities but it may also develop in arteries that go to your head, arms, stomach, and kidney. This article highlights the key intricacies related to surgery for peripheral artery disease to impart optimum awareness.

Peripheral artery disease (PAD) is a condition which is caused by the accumulation of plaque in the form of fat and cholesterol in the arteries. The medical terminology for this condition is atherosclerosis, and it is treated by conducting peripheral artery surgery in severe cases.

Individuals with severe PAD cases involving open sores, intermittent claudication and serious bone, skin, or tissue problems undergo surgeries. Moreover, this artery blockage due to plaque build-up can cause disturbance in the blood flow from the heart to every part of your body. Left untreated can also lead to a stroke or heart attack.

Peripheral artery surgery helps open this blockage and reroute blood flow to reach your heart. The three types of surgery you can go through include:

• Aortobifemoral: Rerouting blood from the abdominal aorta to two femoral arteries present in your groyne.
• Femoropopliteal: Rerouting blood from the femoral to the popliteal arteries below and above your knees.
• Femorotibial: Rerouting blood between the tibial artery and the femoral artery.

After the doctor performs bypass surgery to treat PAD in your leg, you can expect to treat blockage in your arteries along with symptoms like:

• Pain in your toes or feet
• Numbness, heaviness, or weakness in your muscle
• Non-healing wounds around pressure points
• Gangrene

1. Bypass Grafting

In this procedure, an alternate channel is created to redirect the blood flow around the blocked arteries. This blood flow bypasses the damaged artery due to plaque formation. The graft used in this procedure can be synthetic material or a healthy section of another artery in the hip or thigh. During this peripheral artery surgery, the patient will receive anaesthetic medicine depending on which artery is being treated.

Survival Rate After Surgery

90-95%

Cost of the Surgery

₹ 95,000 to ₹ 3,50,000

2. Stenting or Balloon Angioplasty

Balloon angioplasty involves a specialist surgeon inserting a balloon catheter inside the blocked artery. After the insertion, the balloon is expanded, which pushes the plaque and accumulated fats against the wall and increases the passage. Once done, the balloon and the catheter are removed after the doctor ensures that the blood flow is improved.

Stenting is a common peripheral vascular disease surgery, as most healthcare professionals recommend this process to their patients. In this process, a stent is left in the blocked artery so that it stays open and does not limit blood flow.

Survival Rate After Surgery

• One year: 87.4%
• Two years: 85.1%
• Three years: 83.2%

Cost of the Surgery

Starting from ₹ 1,28,000 approximately

3. Cryoplasty

Cryoplasty is also known as cryo-balloon angioplasty, which is a similar procedure that a surgeon conducts in normal balloon angioplasty. However, in this case, the balloon catheter inserted in the blocked artery is filled with liquid nitrous oxide. The solution evaporates immediately into gas, leading to the balloon's inflation and freezing the tissue around.

This dilates the artery, enhancing blood flow and reducing the chances of the growth of damaged tissue. Moreover, it minimises the future possibilities of plaque formation in similar arteries.

Survival Rate After Surgery

• 68% in initial cryoplasty
• 71% for in-stent procedures

4. Laser Atherectomy

Laser atherectomy is a PAD vascular surgery where a specialised catheter is inserted in the blocked artery. This procedure is mostly conducted to remove the atherosclerotic plaque in the arteries that is caused due to fat and cholesterol formation. The highlight of the catheter is that it contains a sharp rotating blade that scrapes all the plaque accumulation from the artery wall. This procedure reduces the occurrence of debris in the same spot to a great extent.

Survival Rate After Surgery

92-93% within six months follow-up

Cost of Surgery

Starting from ₹ 2,60,000, approximately

As you consult with your doctor about going through this procedure, he or she, along with the treatment team, will guide you on what to expect before the surgery for peripheral artery disease. However, some suggestion that can help you smoothen your surgery includes:

1. Information to Give to Your Doctor

Make sure you reciprocate the following important information to your doctor:

• History of bleeding issues (if any)
• Allergies to latex, medicines, iodine, tape, and anaesthetic agents (if any)
• Medication and supplements that you are already taking

2. Tips to Follow on the Day of Surgery

Here are some suggestions that you can follow to avoid any unnecessary trouble on the day of surgery:

• Wear comfortable clothes when coming to the hospital.
• Try not to wear any jewelry to the hospital as you may have to remove them prior to surgery.
• Remove nail polish and makeup before heading to the hospital.
• If you have glasses, dentures, or hearing devices you usually wear at home, wear them during the procedure too.

The following are certain risk factors that you may experience after going through PAD vascular surgery:

• Swelling, bleeding or pain where the incision was made
• Shortness of breath
• Dizziness
• Fever or chills
• Chest pain
• Belly pain
• Swollen legs
• Incision opening-up

Your doctor may ask you to get multiple tests to ensure proper diagnoses. These include:

• Blood Tests: Doctors suggest having a blood test to detect the condition of your peripheral artery disease. It indicates if you have high triglycerides, high cholesterol, and diabetes.
• Ultrasound of the Feet and Legs: During an ultrasound, a sound wave reaches your legs or feet to check the blood flow through your blood vessels. The radiologist will use a special type of ultrasound, i.e., doppler ultrasound, to spot blocked and narrowed arteries.
• Ankle-Brachial Index (ABI): It is a common diagnosis to identify PAD. The doctors use this method to compare the blood pressure in your ankle with that in your arms. For this purpose, you may be asked to walk on a treadmill while the nurse records your blood pressure reading to check the flow in your arteries.
• Angiography: This test involves a CT scan, MRI, and X-rays to spot the blockage in your arteries. Before the procedure starts, your doctor will inject dye or contrast into your blood vessels, making your arteries easily visible when taking test images.

You can expect the PAD surgery to last for 3 to 4 hours. However, you may have to spend a few more hours preparing and observing. The general procedure the doctors follow while performing this surgery starts with you changing into the hospital gown.

Preparation

A nurse will prepare you by starting an intravenous line in your arm that will keep a check on your fluids and medications. Later, he or she will give you a sedative to relax. Before the surgery starts, you will receive either regional anesthesia or local anaesthesia.

Regional anaesthesia only numbs the area in which surgery is to be performed. On the other hand, local anaesthesia makes you feel sleepy completely. So, talk to your doctor before about the type of anaesthesia you will be receiving.

Operation

Once you enter a sleep state, the doctors will insert a breathing tube into your lungs through your throat and connect you to a ventilator. It will ensure normal breathing during the procedure.

The procedure will begin with the doctor making an incision in your leg. The site will depend on the area of artery blockage, which requires a bypass. Here, the doctor will use an artificial graft or a vein from your leg to bypass the blocked artery, depending on your case and condition.

After identifying the graft, your doctor will attach it to the diseased artery and verify if the blood is flowing properly through it. For this purpose, they may suggest performing an arteriogram. It is a type of X-ray that helps see inside the artery.

Once the surgery is complete, doctors will close your incision using sutures or a closure device.

After the successful surgery, you will remain under the observation of doctors in the ICU ward of the hospital. Generally, you can expect to get discharged from the hospital 2 to 4 days after the procedure. However, some guidelines about your state that you can expect after surgery include:

• There will be soreness and tenderness in and around your incision for several days.
• The nurse will connect you with a monitor that will record essential signs, circulations, incision site, movement, and sensation in the affected part.
• You will receive painkillers to deal with the discomfort.
• Doctors will give you certain instructions for recovery that you must follow.
• You can be on special IV medicines if you experience an uncontrollable bleeding situation or high blood pressure.
• When the time is appropriate, nurses will help you get out of bed and even walk around.

As most people with peripheral artery disease highlight mild or nearly no symptoms, it becomes difficult to decipher the right time to approach a doctor. However, if there is persistent leg pain while walking, known as claudication or numbness, then it is essential to consult with a healthcare professional.

Apart from surgical procedures, peripheral artery disease can be treated with medicines when diagnosed after detecting early symptoms. Some of the popular medications that act as an alternative to peripheral vascular disease surgery are:

• Cholesterol drugs like statins reduce the chances of heart attack or stroke.
• Medication to regulate blood pressure
• Drugs to control glucose levels in the blood
• Clopidogrel acts as a prevention of blood clots
• Cilostazol for reducing leg pain.

You may have soreness in your incision for several days, but you will be able to walk after 4 to 5 days. However, you can expect a full recovery only after 6 to 8 weeks.

This is all the information on surgery for peripheral artery disease. From the above, we can gather that it is a minimally invasive procedure that you may require for blocked arteries, usually in the legs. The bypass procedure helps restore the blood flow through your leg into the heart, thus avoiding stroke and heart attack. Follow the instructions to learn more about what to expect from this procedure.