The doctor will recommend a treatment plan for the patient based on the symptoms, test results, medical history and future potential risks.

Lifestyle Changes and Medications

By making lifestyle changes or taking medication, surgery or other procedures may be able to be avoided. Here are some things a Physician may recommend:

• Lifestyle changes – A healthy diet and exercise are other key lifestyle changes to help control PAD.
• Medications – Along with recommending lifestyle changes, your doctor may prescribe medications (pills) to slow the progress of the disease or to ease some symptoms.

Drug-Coated Balloon Angioplasty

Drug-Coated Balloon (DCB) angioplasty is similar to balloon angioplasty procedurally, but there is the addition of an anti-proliferative medication coating the balloon, as well as an excipient to aid in drug transfer.

Angioplasty with a drug-coated balloon is done in a catheterisation lab (“cath lab”). The doctor injects a special dye through a long, thin tube called a catheter into the bloodstream. The dye allows the doctor to view the arteries on an x-ray monitor. A device with a small balloon on its tip is then inserted through an artery in the leg and is threaded through the arteries until it reaches the narrowed area. The balloon is inflated which flattens the plaque against the wall of the artery, opening the artery. Then the balloon is deflated and removed from the body. Once that is complete, a new balloon, which is coated with an anti-proliferative medication, is inserted through the same artery in the leg and is threaded through the arteries until it reaches the previously treated narrowed area. The balloon is then inflated, and the medication on the balloon surface is delivered to the artery wall and surrounding tissue. After a designated period of time, the doctor will deflate the balloon and remove it. They will then evaluate if any further treatment is necessary to maintain healthy blood flow through the area treated.

Benefits:

Aims to reduce narrowing of the artery which helps improve blood flow. 

Risks:

• The insertion site may bleed or become infected
• The artery may become blocked again (restenosis)
• The artery may tear (artery dissection)
• The artery may develop a hole (artery perforation)

Balloon Angioplasty

Balloon angioplasty is done in the catheterisation laboratory ("cath lab"). The doctor injects a special dye through a small, thin tube called a catheter into the bloodstream. The dye allows the doctor to view the arteries on an X-ray monitor. A device with a small balloon on its tip is then inserted through an artery in the leg or arm and threaded through the arteries until it reaches the narrowed area. The balloon is inflated to flatten the plaque against the wall of the artery, opening the artery. Then the balloon is deflated and removed from the body.

In balloon angioplasty, a special balloon is
temporarily inserted into an artery narrowed by
plaque buildup and inflated slightly to flatten the
plaque against the artery wall, opening the
artery.

More: Risks

Stent Therapy

The doctor may recommend placing a stent to reopen the blocked artery. A stent is a small, expandable, mesh-like tube that supports the artery and helps to keep it open.

Implanting a stent does not require open surgery. The doctor inserts a catheter into an artery in the arm or leg, similar to the balloon angioplasty procedure. A specially designed catheter delivers the stent to the narrow area in the artery. The stent is expanded, flattening the plaque against the artery wall and holding the artery open with a mesh tube. The catheter used to deliver the stent is then removed, but the stent stays in your artery permanently.

A stent is a tiny, expandable, mesh-like tube
that helps support the artery.

More: Risks

Open Surgery

There are several types of open surgery that may also be used to treat PAD. Two of common surgeries are endarterectomy and bypass.

Endarterectomy

An endarterectomy is a procedure that removes plaque directly from the inside of the artery wall.

During this procedure, a doctor makes a small incision (cut) along the blocked or narrowed artery and physically removes the plaque. In some cases, the blocked portion of the blood vessel is also removed. After the plaque has been removed, the artery is closed with stitches or by a patch made from your own vein or synthetic material. Blood flow is then restored through the artery and the outer incision is closed. Patients usually stay in the hospital for one to two days to continue their recovery at home.

Benefits:

An endarterectomy is designed to restore blood flow and help relieve PAD symptoms.

Risks:

• The artery may become blocked again (restenosis).
• You may experience temporary skin numbness and swelling around the incision site.
• The surgery requires conscious sedation or general anesthesia, which increases health risks.
• Complications like stroke, infection, and deep vein thrombosis are possible.

Bypass

The doctor may choose to do a bypass in more serious cases of PAD where blockages are very long or very hard (calcified). This procedure uses a graft – either a healthy blood vessel from another part of the body, or a synthetic tube – to reroute the blood flow around a blocked artery and create a new, permanent pathway for blood to flow.

The procedure is done in a hospital under general anesthesia. The doctor makes a small opening near the blockage in the diseased artery. The graft is then attached (grafted) above and below the blockage, creating a new passageway for blood to flow (bypass) around the blocked artery. During the procedure, the doctor may do an angiography or ultrasound to check the bypass for any problems and to make sure it is working properly.

Bypass procedure

Benefits:

• The surgery is designed to restoring blood flow and relieving PAD symptoms.

Risks:

• The surgery requires general anesthesia (you are not conscious during surgery), which increases health risks.
• The affected blood vessel could be injured.
• Your recovery time may be long.
• Infection is possible.

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