Terms such as “angioplasty” and “stenting” are commonly used in discussions of possible treatments for coronary arteries that are narrowed or blocked due to plaque buildup, but the heart isn’t the only area where arterial blockages can occur. Peripheral arteries in the legs are subject to the same risks as the arteries that are responsible for delivering oxygen- and nutrient-rich blood throughout the body.
“There are a number of situations or conditions in which a peripheral endovascular procedure with angioplasty and stenting may be needed,” explains Peter Connolly, MD, associate professor of clinical vascular surgery at Weill Cornell Medicine. “One such condition is peripheral arterial disease, or PAD, which is a manifestation of atherosclerosis (narrowing of the blood vessels). If PAD becomes symptomatic, with severe leg cramping and limited ambulatory range [the distance one is able to walk] or non-healing sores or ulcers in the toes or feet, then an intervention may be indicated with angioplasty and stenting.”
Procedures That Open Arteries
During an angioplasty, a doctor inserts a long, flexible catheter into an artery and threads it to the area that is narrowed or blocked. At the tip of the catheter is a tiny, deflated balloon. When the tip reaches the area that is narrowed, the balloon is inflated, and the fatty plaque that forms the blockage is pushed away from the center of the artery to its walls and restores blood flow. Stenting entails the placement of a flexible wire mesh tube (a stent) into the artery to help keep it open. Angioplasty and stenting in the peripheral leg arteries functions very similar to comparable interventions in the coronary arteries.
Other Arterial Conditions
Another condition that can occur in the leg is a popliteal areterial aneurysm, in which the popliteal artery, which is located behind the knee joint, becomes dilated, increasing the risk of blood clot formation. To prevent blood clots from traveling down the leg, a covered stent may be placed in the artery to seal off the dilated portion of the blood vessel.
The other category of PAD is critical limb ischemia, a condition that can have a much more devastating result, according to Dr. Connolly. Critical limb ischemia is severe obstruction of the arteries that has resulted in the development of sores or ulcers on the feet.
“These non-healing wounds can lead to gangrene and eventual limb loss in more severe cases. In these situations, revascularization with angioplasty and stenting is crucial to ensure healing and prevent amputation,” notes Dr. Connolly.
Risks and Benefits
There are clear benefits to angioplasty and stenting for some peripheral artery conditions, but, as with any medical procedure, there are risks to be considered.
“Perhaps the most important consideration is the durability of these procedures,” says Dr. Connolly. “Simply put, just because you have an angioplasty or stenting procedure does not mean that you are cured. We have relatively high failure rates of these procedures, particularly due to what is called intimal hyperplasia—the proliferation of scar tissue within the artery in response to these interventions.”
Dr. Connolly says that women are more likely than men to require repeat interventions to keep arteries open. Women’s arteries also tend to be smaller; as a result, some of the stents that are commercially available may be unsuitable for these smaller vessels.
“Patients with severe symptoms of PAD, such as tissue loss or gangrene, should definitely have an intervention. However, patients with mild to moderate symptoms will probably do best with an exercise program and lifestyle modifications,” explains Dr. Connolly.
If you do have any interventions for PAD, including angioplasty or stenting, it is very important that you follow up with your doctor regularly for ongoing evaluation of your artery health.
“Nearly 50 percent of patients having one of these procedures will require another procedure to maintain adequate blood flow,” notes Dr. Connolly.
Lifestyle Is Key
There are also lifestyle changes that you can make to improve your circulation.
“First and foremost, if you are a smoker, stop. This can prevent worsening of PAD and will also improve your overall health. Second, a walking program can be of tremendous benefit to your circulation. Walking exercise can improve the circulation in the smaller blood vessels. Furthermore, diligent participation in a walking program can frequently improve ambulation range [how far you can walk] to the point that an intervention, such angioplasty and/or stenting, is unnecessary,” advises Dr. Connolly.
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