Balloon angioplasty and stenting

Why it’s done?

If you have narrowing or blockages in the arteries in your legs and:

• Pain with walking (claudication)
• Severe foot pain (ischaemic rest pain)
• Non-healing ulcers
• Gangrene

Description

Balloon angioplasty and stenting is performed under local anaesthetic.

The femoral artery in groin is accessed under ultrasound and a small plastic sheath is inserted. A wire and catheter inserted through the sheath in the groin are then advanced through the narrowed or blocked artery. An angioplasty balloon is then used to dilate the narrowed or blocked segment of the artery. If required a stent (a small metal mesh tube) is inserted and deployed. The stent is then expanded with a balloon and a final angiogram taken to ensure a satisfactory result has been achieved.

The sheath is removed from the groin and a plug is placed in the femoral artery.

Risks:

• Bleeding from the femoral artery access site in the groin.
• Damage to the arteries.
• Re-narrowing or blockage of the treated artery in the future.
• There is a small risk of requiring surgery due to complications of the procedure 1-2%.

What can I expect after treatment?

You will need to lie flat and rest in bed for several hours after the procedure.

Typically you will be discharged home after 24 hours.

You can expect to return to normal activities within 48 hours.

You should not drive for 48 hours after an angioplasty or stent.

Your treated artery will be monitored with ultrasound.

Bypass Surgery

Why it’s done?

If you have a long blockage in an artery in your leg and:

• Pain with walking (claudication)
• Severe foot pain (ischaemic rest pain)
• Non-healing ulcers
• Gangrene

Description

Bypass surgery is performed under general anaesthetic.

An artery above and below the blockage is exposed by making an incision in the skin and dissecting the arteries. Either a vein graft is harvested from your leg or a prosthetic bypass graft is used to perform the bypass. The graft is sewn to the artery above the blockage and below the blockage to supply blood beyond the blockage. The wounds are closed with dissolving sutures and a drain is left in place (usually removed after 24 hours).

Risks:

• Infection.
• Bleeding.
• Blockage or narrowing of the bypass.
• Leg swelling.
• Nerve damage – numbness or pain.

What can I expect after treatment?

You will be in hospital for 5 – 7 days.

Your leg will be swollen after the procedure, this may take several months to improve and in a small number of patients does not completely resolve.

You be able to resume normal activities after 1-2 weeks.

You will be able to resume strenuous activities after 6 weeks.

You will be able to resume driving after 4 weeks.

Surgery to remove plaque (Endarterectomy)

Why it’s done?

If you have a short narrowing or blockage in an artery in your leg (usually in the groin) and:

• Pain with walking (claudication)
• Severe foot pain (ischaemic rest pain)
• Non-healing ulcers
• Gangrene

Description

Endarterectomy is usually performed under general anaesthetic.

An incision is made over the blocked artery. The artery is dissected to allow clamping above and below the blockage. The blocked artery is then clamped and opened. The plaque is removed and the artery is repaired by stitching on a vein patch (harvested from you leg) or a synthetic patch. The wound is closed with dissolving sutures and a drain is left in place (usually removed after 24 hours).

Risks:

• Infection.
• Bleeding.
• Leg swelling.

What can I expect after treatment?

You will be in hospital for 3 – 5 days.

Your may have some leg swelling after the procedure, this usually improves within a few months.

You be able to resume normal activities after 1-2 weeks.

You will be able to resume strenuous activities after 6 weeks.

You will be able to resume driving after 2 – 4 weeks.