Treatment of Arterial Blockages

How are arterial blockages treated?

Various techniques can be used to increase the flow of blood through the arteries. The most current interventions for treating vascular disease can be done quickly and require a short hospital stay and early return to normal activities. Treatments with devices now available include lasers, atherectomy, balloon catheters, and stents. These new treatments remove or displace the plaque that blocks blood flow to the lower extremity. During these procedures, dye is injected at certain times and X-rays are taken to determine whether the artery has been opened adequately. If it hasn't, the treatment will be continued or repeated.

Thrombolytics

If the suspected cause of the blockage is due to blood clots, strong, clot-busting drugs called thrombolytics can be administered. A catheter is guided to the site of the blood clot in the artery. The thrombolytic drug is administered through the catheter until the clot is dissolved.

Mechanical Thrombectomy and Embolectomy

This is a procedure for removing blood clots (thrombus) from an artery with a balloon catheter. A deflated balloon attached to a catheter is passed through the artery beyond the clot and inflated. It is then pulled back through the artery, scooping the blood clot away as it passes back.

 

Balloon Angioplasty

This is the most common method used for opening an obstructed artery. A guide wire is first passed through the narrowed part of the artery. A deflated balloon, attached to a catheter (a thin, flexible tube), is passed along the guide wire through the vessel to the area of narrowing.

The balloon is then inflated and deflated, sometimes more than once and often in more than one location. This flattens the plaque against the vessel wall, increasing the size of the opening in the artery. Balloon angioplasty may be the only treatment needed, or it can be used along with one or more of the other options

Stents

After an artery has been opened your physician may choose to insert a stent to hold the vessel open. This tiny, expandable device is made of metal and mounted on a deflated balloon attached to a catheter. When the catheter is in position at the site of the blockage, the balloon is inflated and the stent is expanded. The balloon catheter is then removed, allowing blood to flow through the artery again. The expanded stent, which looks like a rolled piece of fence, remains in place permanently.

Atherectomy

An atherectomy catheter has a small rotating cutter at its tip that either cuts or pulverizes plaque that is blocking an artery.

Laser Angioplasty

Uses an excimer laser to remove arterial blockages and improve blood flow. Laser angioplasty is minimally invasive and is similar to balloon angioplasty. A laser catheter emits ultraviolet light to remove the blockage by evaporating the plaque. Ultraviolet light is much cooler than infrared ("hot") lasers so it reduces the risk of damage to the surrounding tissue.

If there are multiple blockages, the laser catheter can be moved from blockage to blockage. Once all the blockages are ablated, the catheter is withdrawn and X-ray contrast dye is injected into the blood vessel, allowing the physician to assess the results of the procedure. Additional balloon angioplasty may be undertaken at this point.

Bypass

A narrowed or blocked section of an artery can be detoured or bypassed with grafts. A graft may be synthetic, or it may be a natural vein taken from another part of the body. One end of the graft is attached to an artery above the blocked area, and the other to an artery below the blockage. Blood then travels from the artery above, through the bypass graft, and to the artery below the blockage, where it circulates to the lower part of the leg and foot. Bypass surgery is more invasive than catheter based interventions and will require a longer hospitalization and recovery period.