Oregon Heart and Vascular Institute - Peripheral Artery Disease

WHAT IS PERIPHERAL ARTERY DISEASE? | DISEASES | TESTS AND PROCEDURES | SURGICAL TREATMENT | NONSURGICAL TREATMENTS

What is peripheral artery disease?
Peripheral artery disease is a general term for damage, defects, or blockage in the peripheral arteries. These arteries carry blood and supply oxygen to the hands and feet. Anyone can develop peripheral artery disease, but it is most common in people over the age of 50. Peripheral artery disease is sometimes called peripheral arterial disease, or PAD.

Peripheral artery disease of the legs is the most common PAD, but the condition affects others parts of the body as well. Carotid artery disease occurs in the arteries of the neck. In renal artery disease, the arteries leading to the kidneys are blocked. Mesenteric artery disease (also called mesenteric artery ischemia) is a narrowing or blockage of one of the arteries supplying the large and small intestines. One of the most serious forms of peripheral artery disease is abdominal aortic aneurysm. This condition involves an abnormal widening of the aorta, the main blood vessel that carries blood from the heart to the rest of the body.

What causes peripheral artery disease?
The most common cause of peripheral artery disease is arteriosclerosis, or hardening of the arteries. Arteriosclerosis results from a buildup of fat and cholesterol inside the arteries. This buildup, known as plaque, clogs the arteries. PAD can also develop from blood clots in the vein.

What causes blood clots?
A blood clot forms in the vein when the walls of the vein become weak and blood flows slowly through the vein. The walls can become weak through an injury, a long period of bed rest or inactivity, major surgery, pregnancy, or being overweight. Smoking, some cancers, and the use of birth control pills may also cause walls of the vein to become weak.

What are the symptoms of peripheral artery disease?
The most common symptom of peripheral artery disease is pain in the leg, particularly when walking or exercising. Other symptoms include numbness and tingling in the lower legs and feet, coldness in the lower legs and feet, and sores on the leg that do not heal.

How is PAD diagnosed?
PAD is diagnosed through a physical examination that includes a check of your blood pressure and your heart. You may, however, have to undergo some additional tests. Common tests include duplex ultrasound, Doppler ultrasound imaging, arteriogram, CAT scan, magnetic resonance angiography, and renal angiogram.

How is it treated?
In some cases, lifestyle changes — such as quitting smoking, exercising, and controlling weight — can keep peripheral artery disease under control.

There are treatments for peripheral artery disease that do not require surgery. Carotid stenting, angioplasty and stenting for the peripheral arterial leg disease, renal artery angioplasty with stent, and abdominal aortic stent graft are some of the common and safe nonsurgical treatments.

In severe cases, you may have to undergo surgery. A number of proven surgical procedures have been developed to treat PAD. They include carotid endarterectomy, femoropopliteal bypass, tibioperoneal bypass, mesenteric bypass, and abdominal aortic bypass.

Your doctor will recommend the best treatment for your particular condition.

DISEASES

Carotid Artery Disease

What is carotid artery disease?
Carotid artery disease is damage or blockage in the carotid arteries. These are the arteries in the neck that carry oxygen-rich blood to the head and brain. When the brain does not receive enough oxygen, there is an increased risk of stroke.

What causes it?
Carotid artery disease is caused by atherosclerosis (hardening of the arteries). The arteries become narrowed and stiff (hardened) when plaque, a fatty material, builds up in them.

High cholesterol, high blood pressure, obesity, smoking, lack of exercise, diabetes, and genetics (family history) can contribute to carotid artery disease.

What are the symptoms of carotid artery disease?
There are no specific symptoms to warn you of carotid artery disease. However, the general warning signs of stroke may indicate blockage in the carotid arteries. These signs include episodes of headache; dizziness; confusion; trouble swallowing; and numbness or paralysis of the face, legs, or arms. These episodes can last from several minutes to several hours.

How is it diagnosed?
By listening with a stethoscope to the blood flow through your carotid arteries, your doctor can usually tell if there is blockage. To be sure, your doctor may call for additional tests such as carotid duplex ultrasound, magnetic resonance angiography, or arteriography.

How is carotid artery disease treated?
Lifestyle changes to lower the risk of stroke are the first treatment. These changes include lowering cholesterol, controlling high blood pressure, losing weight, quitting smoking, and exercising regularly. In some cases, doctors prescribe a daily dose of aspirin or blood-thinning medications.

In more serious cases of carotid artery disease, surgery may be called for. Two common types of surgery are carotid endarterectomy and carotid artery stenting, a minimally invasive procedure.

Abdominal Aortic Aneurysm

What is abdominal aortic aneurysm?
Abdominal aortic aneurysm (AAA) is an abnormal bulging or stretching — usually referred to as a ballooning — of the section of the aorta located in the abdomen (upper part of the stomach). The aorta is the main artery that carries oxygen-rich blood to all other parts of the body. In the abdomen, the aorta splits into smaller arteries that carry blood to the legs and feet. The most common site for this type of aneurysm is just above the split.

AAA can lead to atherosclerosis (hardening of the arteries) and high blood pressure. If not treated, the aneurysm could rupture (burst). Ruptured aneurysms are often fatal and one of the leading causes of death in the United States. AAA can develop in anyone but is most common in men between the ages of 40 and 70.

What causes it?
The exact causes of AAA are not fully known. Some suspected causes are infection; injury from a blow to the stomach; smoking; family history of aneurysms; and a weakening of the artery wall, which some people are born with.

What are the symptoms of abdominal aortic aneurysm?
Many times there are no warning signs of an abdominal aortic aneurysm, even one about to rupture. When symptoms of an aneurysm do occur, the most common ones are fatigue, severe pain in the abdomen or lower back, and the sensation of a pulse or heartbeat in the abdomen.

When an aneurysm ruptures, the symptoms include sudden intense pain, heavy sweating, rapid heartbeat, dry mouth, nausea, vomiting, near fainting, fainting, and shock. A ruptured aneurysm is a life-threatening situation and calls for immediate medical care.

How is it diagnosed?
A thorough physical examination can detect most, but not all, abdominal aortic aneurysms. Your doctor can feel a large aneurysm and, with a stethoscope, hear abnormal blood flow in your abdomen. Your doctor may recommend additional tests such as duplex ultrasound or arteriography.

How is abdominal aortic aneurysm treated?
A small aneurysm usually requires no treatment, only regular monitoring by a doctor. A larger aneurysm, however, requires treatment to prevent it from rupturing. Treatment involves surgery, abdominal aortic bypass, or renal artery angioplasty with stent, a nonsurgical procedure.

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Mesenteric Artery Ischemia

What is mesenteric artery ischemia?
Mesenteric artery ischemia — also called MAI, mesenteric vascular disease, chronic mesenteric ischemia, and acute mesenteric ischemia — is a narrowing or blockage of one or more of the mesenteric arteries. These three arteries carry oxygen-rich blood to the small and large intestines. The large intestine contains the colon. MAI generally affects people past the age of 60.

What causes it?
MAI is caused by a narrowing or blockage of one or more of the three mesenteric arteries. This blockage is often caused by a blood clot that breaks away from the heart, travels through one of the mesenteric arteries, and blocks the flow of blood. This type of clot is common in people with abnormal heart rhythms such as atrial fibrillation.

Shock, atherosclerosis (hardening of the arteries), smoking, and high cholesterol can contribute to MAI.

What are the symptoms of mesenteric artery ischemia?
If MAI is caused by atherosclerosis and is chronic (occurring over a long period of time), the most common symptoms are stomach pain after eating and occasional diarrhea. If MAI is caused by a blood clot and is acute (occurring suddenly), symptoms include sudden intense stomach pain, vomiting, and diarrhea. Acute mesenteric artery ischemia is a serious situation and calls for immediate medical care.

How is it diagnosed?
To find exactly where a mesenteric artery may be blocked, your doctor will call for a CT scan or a [mesenteric angiogram].

How is mesenteric artery ischemia treated?
Treating MAI usually requires surgery to remove the blockage, whether it is chronic or acute. Mesenteric bypass surgery is another common treatment.

Renal Artery Disease

What is renal artery disease?
Renal artery disease — also called renal artery occlusion and renal artery stensosis — is a narrowing or blockage of the renal artery. This artery carries oxygen-rich blood to the kidneys. In most cases, the condition affects the arteries leading to only one kidney. Renal artery disease occurs mostly in men between the ages of 50 and 70. If not treated, it can lead to permanent kidney damage.

What causes it?
In people over the age of 50, renal artery disease is usually caused by atherosclerosis (hardening of the arteries). The arteries become narrowed and stiff (hardened) when plaque, a fatty material, builds up in them. In people, particularly women, under the age of 40, the condition is usually caused by a muscle disorder in which abnormal tissue grows in the renal artery and narrows it.

Gout, diabetes, injury to the kidney, high blood pressure, obesity, smoking, lack of exercise, a diet high in fat, and excessive alcohol consumption can contribute to renal artery disease.

What are the symptoms of renal artery disease?
There are usually no symptoms, especially in the early stages. High blood pressure that is difficult to control may be a sign of renal artery disease, but it may also be a sign of other disorders. In the later stages of the disease, the kidneys may fail to function properly.

How is it diagnosed?
By listening with a stethoscope to the blood flow through your renal arteries, your doctor can usually tell if there is blockage. To be sure, your doctor may call for additional tests such as duplex ultrasound, magnetic resonance angiography, or renal angiography.

How is renal artery diseases treated?
Lifestyle changes are the first treatment. These changes include controlling high blood pressure, losing weight, quitting smoking, exercising regularly, decreasing fat in the diet, and lowering alcohol consumption.

In some cases, doctors prescribe medications to lower blood pressure. In other cases, doctors may recommend renal artery bypass surgery or renal artery angioplasty, a nonsurgical procedure.

Peripheral Artery Disease of the Legs

What is peripheral artery disease of the legs?
Peripheral artery disease of the legs — also called arteriosclerosis of the extremities, peripheral vascular disease, peripheral arterial disease, and PAD — is a narrowing and hardening of the arteries that carry oxygen-rich blood to the legs and feet. This narrowing causes a decrease of blood flow that can damage nerves and tissues in the legs and feet. Peripheral artery disease of the legs is most common in people over the age of 50.

What causes it?
Peripheral artery disease of the legs is usually caused by atherosclerosis (hardening of the arteries). The arteries become narrowed and stiff (hardened) when plaque, a fatty material, builds up in them. Hardening of the arteries commonly shows up first in the legs and feet.

Smoking, high blood pressure, diabetes, certain kidney diseases, and a family history of stroke or coronary artery disease can contribute to peripheral artery disease of the legs.

What are the symptoms of peripheral artery disease of the legs?
Symptoms include pain in the thighs, calves, or feet, particularly when exercising; coldness or numbness in the legs or feet; problems walking; loss of hair on the legs or feet; and a change in color of the legs. Generally, symptoms are noticed in only one leg. If both legs have atherosclerosis, the severity of symptoms is different for each leg.

How is it diagnosed?
By listening with a stethoscope to the blood flow through the arteries in your legs or abdomen, and by checking the pulse at your groin, behind your knee, or at the top of your foot, your doctor can usually tell if there is blockage. Your doctor may also call for additional tests such as Doppler ultrasound imaging or magnetic resonance angiography.

How is peripheral artery disease of the legs treated?
Treatment begins with relieving symptoms and self-care. Self-care includes maintaining a diet low in fat, quitting smoking, exercising in moderation to improve circulation, and taking special care of the feet.

In some cases, doctors prescribe pain relievers, blood thinners, or medications to enlarge the affected arteries. In other cases, doctors may recommend femoropopliteal bypass, tibioperoneal bypass surgery, or angioplasty and stenting for peripheral artery disease, a non-surgical procedure.

PERIPHERAL ARTERY DISEASE: TESTS AND PROCEDURES

Carotid Duplex Ultrasound

What is carotid duplex ultrasound?
Carotid duplex ultrasound — also called carotid duplex, carotid ultrasound, and carotid duplex scan — is a noninvasive, painless test that uses high-frequency sound waves (ultrasound) to detect blood clots, plaque (fatty material), or other problems with blood flow in the carotid arteries. These are the arteries in the neck that carry blood to the head and brain.

Who conducts the test?
Licensed and certified vascular technologists conduct the test. A radiologist (a doctor who diagnoses diseases by studying images) or vascular surgeon interprets the results.

How is carotid duplex ultrasound done?
A vascular technologist spreads a warm nongreasy lotion on your neck and then passes a small hand-held instrument called a transducer over the area. The transducer probes the artery and collects the data needed to form an ultrasound image, also called a sonogram. The image is stored in a computer and printed on film or viewed on a monitor. The procedure takes about 15 to 30 minutes.

Is it safe?
The test is perfectly safe and painless. No dyes are injected into the body, and no needles or tubes are used. You will not be exposed to radiation. The lotion spread on your skin does not harm the skin or clothing.

How do I prepare for carotid duplex ultrasound?
The test requires no special preparation. But be sure to tell your doctor if you have any allergies, which medications you are taking, or if you are pregnant.

What happens after the procedure?
After the procedure, the technologist removes the ointment, and you can resume your normal activities. Your doctor will review the images, which may take several days, and recommend treatment if you need it.

Duplex Ultrasound

What is a duplex ultrasound?
Duplex ultrasound is a noninvasive, painless procedure that uses high-frequency sound waves (ultrasound) to measure the speed of the blood flow and to detect blood clots, plaque (fatty material), or other problems with blood flow in the arteries. The test combines the two types of sound waves used in carotid duplex ultrasound and in [Doppler ultrasound].

How is duplex ultrasound done?
A vascular technologist spreads a warm nongreasy lotion on your neck and then passes a small hand-held instrument called a transducer over the area. The transducer probes the artery and collects the data needed to form an ultrasound image, also called a sonogram. The image is stored in a computer and printed on film or viewed on a monitor. The procedure takes 15 to 30 minutes.

How do I prepare for duplex ultrasound?
The test requires no special preparation. But be sure to tell your doctor if you have any allergies, which medications you are taking, or if you are pregnant.

Arteriography

What is arteriography?
Arteriography — also called angiography — is a general term for a minimally invasive test that uses X-rays to examine arteries. X-rays can be taken of almost every artery, including those that carry blood to the head, heart, kidney, or legs. The image created by the X-ray is called an arteriogram or angiogram. The procedure varies slightly, depending on the site of the artery being examined.

Who conducts the test?
A team of technicians and nurses led by a cardiologist (heart doctor) or radiologist (a doctor who diagnoses diseases by studying images) conducts the test.

How is arteriography done?
The test takes place in the hospital. You wear a hospital gown. You receive a local anesthetic and a mild sedative to help you relax, and you remain awake during the procedure.

The physician makes a small incision near an artery in your neck, chest, groin, or arm. Using real-time X-rays displayed on a video screen for guidance, the physician then inserts a thin flexible tube called a catheter into the artery. Once the catheter is placed in the exact spot, the doctor injects a dye. The dye travels through your artery making the artery easier to see in the X-ray.

Is it safe?
Arteriography is a very common test. Both the X-ray and the dye are safe. The exposure to radiation is low. There is a remote chance you may react to the dye.

You may feel a slight burning sensation when the doctor injects the dye. You may feel discomfort at the site where the catheter is inserted, but you will not feel the catheter inside your body. There is a small risk of bleeding, pain, or infection at the site where the catheter is inserted.

How do I prepare for arteriography?
You should not eat or drink anything for six hours before the procedure. Be sure to tell your doctor if you have any allergies, which medications you are taking, or if you are pregnant.

What happens after the procedure?
After the test, a nurse will apply a pressure bandage at the site where the catheter was inserted. You may feel tenderness or soreness at the site.

Depending on where the catheter was inserted, you may have to remain in bed — in the hospital or at home — for several hours up to a day.

Renal Arteriography

What is renal arteriography?
Renal arteriography — also called renal angiography — is a minimally invasive test that uses X-rays to examine the arteries of the kidneys. The image created by the X-ray is called a renal arteriogram or renal angiogram.

Who conducts the test?
A team of technicians and nurses led by a vascular surgeon or radiologist (a doctor who diagnoses diseases by studying images) conducts the test.

How is renal arteriography done?
The procedure takes place in the hospital. You wear a hospital gown. You receive a local anesthetic and a mild sedative to help you relax, and you remain awake during the procedure.

The doctor makes a small incision in your leg. Using real-time X-rays displayed on a video screen for guidance, the doctor then inserts a thin flexible tube called a catheter into an artery. The doctor threads the catheter through the abdominal aorta to the kidney. Once the catheter is in place, the doctor injects a dye. The dye travels through your artery making the artery easier to see in the X-ray.

Is it safe?
Renal arteriogrpahy is a very common test. Both the X-ray and the dye are safe. The exposure to radiation is low. There is a remote chance you may react to the dye. You may feel a slight burning sensation when the doctor injects the dye. You may feel discomfort at the site where the catheter is inserted. There is a small risk of bleeding, pain, or infection at the site where the catheter is inserted.

How do I prepare for renal arteriogrpahy?
You should not eat or drink anything after midnight the night before the procedure. Be sure to tell your doctor if you have any allergies, which medications you are taking, if you tend to bleed a lot, or if you are pregnant.

What happens after the procedure?
After the test, a nurse will apply a pressure bandage at the site where the catheter was inserted. You may feel tenderness or soreness at the site. You will have to keep your leg straight for about 12 hours after the test.

CT Scan

What is a CT scan?
A computed tomography (CT) scan — also called a computed axial tomography (CAT) scan — is a noninvasive, painless test that uses an X-ray to make detailed pictures (images) of structures inside the body. Directed by a scanner, the X-ray beam circles the body, helping produce many images. The images are stored in a computer and can be printed on film or viewed on a monitor. The computer can create 3-dimensional models of parts of the body by assembling the individual images. CT scans can deliver information about almost every organ, bone, and blood vessel in the body.

Who conducts the test?
Licensed and certified radiological technologists conduct the test. A radiologist (a doctor who diagnoses diseases by studying images) interprets the results.

How is a CT scan done?
The test takes place in the hospital, and you wear a hospital gown. You remove all jewelry, dentures, hearing aids, and other medal objects from your body. You lie on your back on a table that moves into and through a tunnel-like chamber inside the scanner.

At times during the procedure, the technologist asks you not to move and to hold your breath while images are being taken. If your test is to examine blockage in an artery or vein, you receive an injection of a dye into the artery or vein to make it show up better on the image. The test takes between 5 and 30 minutes.

Is it safe?
A CT scan is painless. Both the X-ray and the dye are safe. The exposure to radiation is low. There is a remote chance you may react to the dye.

When the technologist injects the dye, you may feel a slight burning sensation or itching, or experience a metallic taste in the mouth or warm flush in the body. These feelings are normal and usually last for only a few second.

If you are nervous about being in a tight space (claustrophobia), ask for a sedative to help you relax.

How do I prepare for a CT scan?
The test requires no special preparation. But be sure to let your doctor know if you have any allergies, which medications you are taking, or if you are pregnant.

What happens after the procedure?
Following the procedure, you can resume your normal activities. Your doctor will review the images, which may take several days, and recommend treatment if you need it.

Magnetic Resonance Angiography

What is magnetic resonance angiography?
Magnetic resonance angiography (MRA) — also called magnetic resonance imaging and nuclear magnetic resonance imaging — is a noninvasive, painless test that uses powerful but harmless magnets and radio waves to make detailed pictures (images) of arteries and veins. The images are stored in a computer and can be printed on film or viewed on a monitor. MRA can often detect problems in arteries or veins that X-rays and other forms of imaging cannot.

Who conducts the test?
Licensed and certified radiological technologists conduct the test. A radiologist (a doctor who diagnoses diseases by studying images) interprets the results.

How is magnetic resonance angiography done?
The test takes place in the outpatient center. The procedure takes between 30 and 90 minutes, depending on what part of the body is examined.

You lie on your back on a table that moves into and through a tunnel-like chamber inside the scanner. Because of the strong magnetic field, you remove all jewelry, dentures, hearing aids, and other medal objects from your body. Your arms, chest, or head may be gently strapped down to help you remain still. Small coil-like devices that send and receive radio waves may be placed on your arms, chest, or head. You may receive an injection of a dye into an artery or vein to make it show up better on the image.

Is it safe?
You feel no pain or discomfort during an MRA. Lying motionless on a hard table, however, may be uncomfortable.

If you are nervous about being in a tight space (claustrophobia), ask for a sedative to help you relax.

How do I prepare for magnetic resonance angiography?
The test requires no special preparation. But be sure to let your doctor know if you have any allergies, which medications you are taking, or if you are pregnant.

PERIPHERAL ARTERY DISEASE: SURGICAL TREATMENTS

Abdominal Aortic Bypass

What is an abdominal aortic bypass?
An abdominal aortic bypass is a surgical procedure performed to repair or reroute blood around an aneurysm (bulge) in the aorta, the main artery that carries blood from the heart to the rest of the body. The procedure is done when the aneurysm is not yet dangerously large. If the aneurysm is large and in danger of bursting, surgery is done to remove it.

Who performs the surgery?
The surgery is performed by a team of medical professionals led by a thoracic surgeon (a doctor who specializes in surgery of the heart, chest, and lungs) or a vascular surgeon (a doctor who specializes in the treatment of blood vessels).

How is an abdominal aortic bypass done?
You receive a general anesthetic and remain asleep and feel no pain during the operation.

The surgeon makes an incision in your abdomen, locates the aorta, and places a clamp on it above the aneurysm to stop the flow of blood for a short time. The surgeon repairs the aneurysm by removing the material that is causing the bulge. The surgeon then sews a graft onto the aorta above and below the aneurysm. The graft is either a piece of healthy blood vessel taken from your body, or an artificial blood vessel made from a synthetic material. This graft replaces the aneurysm and carries the blood from the aorta to the rest of the body.

The surgeon then removes the clamp and sews up the incision in your abdomen.

What are the risks?
Abdominal aortic bypass carries the same risks as any other general surgery: the possibility of infection, bleeding, and reaction to anesthesia.

If there is plaque (fatty material) in the blood vessels, there is an increased risk of heart attack or stroke during the operation. If the blood supply is cut off too long, there is a possibility of damage to the kidneys. A piece of blood clot may come loose and block an artery in the leg, which may mean additional surgery.

Talk with your doctor and surgeon about the risks.

How do I prepare for an abdominal aortic bypass?
You should not eat or drink anything after midnight the night before the operation. Be sure to tell your doctor what medications you are taking, whether you have any allergies, or if you are pregnant. You should prepare for a stay in the hospital and arrange for someone to take you home.

What can I expect after the surgery?
You will stay in the intensive care unit for 1 to 3 days and in a regular room for 4 to 6 days. You may have a tube through your nose into your stomach to help release air and fluid from your intestines while they heal.

Once you return home, you should avoid strenuous activity and driving for 4 to 6 weeks, or until you no longer feel pain. You can take a normal shower, but avoid baths until the surgical wound heals.

Your doctor will tell you when to come back for a checkup and when to resume your normal activities.

Mesenteric Bypass

What is a mesenteric bypass?
Mesenteric bypass is a surgical procedure performed to reroute blood around blocked or damaged mesenteric arteries. The three mesenteric arteries carry blood to the small and large intestines.

Who performs the surgery?
The surgery is performed by a team of medical professionals led by a vascular surgeon (a doctor who specializes in the treatment of blood vessels).

How is a mesenteric bypass done?
You receive a general anesthetic and remain asleep and feel no pain during the operation.

The surgeon makes an incision in your abdomen near the area of the blocked artery. Next, the surgeon places clamps on the artery above and below the blocked section to stop the flow of blood for a short time. The surgeon then sews a graft onto the artery above and below the blockage. The graft is either a piece of healthy blood vessel taken from your body, or an artificial blood vessel made from a synthetic material. This graft bypasses the blocked artery and carries the blood to the intestines.

The surgeon then removes the clamps and sews up the incision in your abdomen.

What are the risks?
Mesenteric bypass carries the same risks as any other general surgery: the possibility of infection, bleeding, and reaction to anesthesia.

If there is plaque (fatty material) in the blood vessels, there is an increased risk of heart attack or stroke during the operation. A piece of blood clot may come loose and block an artery in the intestines, which may mean additional surgery.

Talk with your doctor and surgeon about the risks.

How do I prepare for a mesenteric bypass?
You should not eat or drink anything after midnight the night before the operation. Be sure to tell your doctor what medications you are taking, whether you have any allergies, or if you are pregnant. You should prepare for a stay in the hospital and arrange for someone to take you home.

Once you return home, you should avoid strenuous activity and driving for 4 to 6 weeks, or until you no longer feel pain. You can take a normal shower, but avoid baths until the surgical wound heals.

Your doctor will tell you when to come back for a checkup and when to resume your normal activities.

Carotid Endarterectomy

What is a carotid endarterectomy?
A carotid endarterectomy is a surgical procedure performed to remove plaque (fatty material) from the carotid arteries, the arteries that carry blood to the head and brain. Blocked carotid arteries can lead to stroke.

Who performs the surgery?
The surgery is performed by a team of medical professionals led by a vascular surgeon (a doctor who specializes in the treatment of blood vessels).

How is a carotid endarterectomy done?
You receive a general anesthetic and remain asleep and feel no pain during the operation.

The surgeon makes an incision in your neck near the area of the blocked artery. Next, the surgeon inserts a tube above and below the blocked section to redirect the blood flow. The surgeon then opens up the blocked artery and removes the plaque.

Alternately, the surgeon may place clamps on the artery above and below the blocked section. This stops the blood flow just long enough for the surgeon to open up the artery and remove the plaque.

The surgeon then sews up the incision in the artery, removes the tube, and closes the incision in your neck.

What are the risks?
Carotid endarterectomy carries the same risks as any other general surgery: the possibility of infection, bleeding, and reaction to anesthesia.

If there is plaque in the artery, there is an increased risk of heart attack or stroke during the operation.

If the blood supply is cut off too long, there is a possibility of damage to the brain.

A piece of blood clot may come loose and block an artery, which may mean additional surgery.

Talk with your doctor and surgeon about the risks.

How do I prepare for a carotid endarterectomy?
You should not eat or drink anything after midnight the night before the operation. Be sure to tell your doctor what medications you are taking, whether you have any allergies, or if you are pregnant. You should prepare for a stay in the hospital and arrange for someone to take you home.

What can I expect after the surgery?
You will stay in the hospital for 1 or 2 days while your conditioned is monitored. Your neck will hurt and you may have trouble swallowing for several days.

Once you return home, you should avoid strenuous activity, especially lifting, for about 3 weeks. You can take a normal shower, but avoid baths until the surgical wound heals.

Your doctor will tell you when to come back for a checkup and when to resume your normal activities.

Most likely, your doctor will recommend lifestyle changes to prevent further buildup of plaque and other problems in the carotid arteries. These changes include lowering cholesterol, controlling high blood pressure, losing weight, quitting smoking, and exercising more. In some cases, doctors prescribe a daily dose of aspirin or blood-thinning medications.

Femoropopliteal Bypass

What is a femoropopliteal bypass?
Femoropopliteal bypass is a surgical procedure performed to reroute blood around blocked or damaged femoral or popliteal arteries. The femoral artery is the main artery that goes through the thigh. As it goes behind the knee, it becomes the popliteal artery. Femoropopliteal bypass surgery is performed when the blockage — known as atherosclerosis (hardening of the arteries) — is severe enough to damage the nerves and tissues of the legs and feet.

Who performs the surgery?
The surgery is performed by a team of medical professionals led by a vascular surgeon (a doctor who specializes in the treatment of blood vessels).

How is a femoropopliteal bypass done?
You receive a general anesthetic and remain asleep and feel no pain during the operation.

The surgeon makes an incision in your leg near the area of the blocked artery. Next, the surgeon places clamps on the artery above and below the blocked section to stop the flow of blood for a short time. The surgeon then sews a graft onto the artery above and below the blockage. The graft is either a piece of healthy blood vessel taken from your body, or an artificial blood vessel made from a synthetic material. This graft bypasses the blocked artery and carries the blood to the leg and foot.

The surgeon then removes the clamps and sews up the incision in your leg.

What are the risks?
Femoropopliteal bypass carries the same risks as any other general surgery: the possibility of infection, bleeding, and reaction to anesthesia.

If there is plaque (fatty material) in the arteries, there is an increased risk of heart attack or stroke during the operation.

A piece of blood clot may come loose and block an artery in the leg, which may mean additional surgery.

Talk with your doctor and surgeon about the risks.

How do I prepare for a femoropopliteal bypass?
You should not eat or drink anything after midnight the night before the operation. Be sure to tell your doctor what medications you are taking, whether you have any allergies, or if you are pregnant. You should prepare for a stay in the hospital and arrange for someone to take you home.

What can I expect after the surgery?
You will stay in the hospital 2 to 4 days after the surgery. You will probably begin walking the first day after the surgery.

Once your return home, you should avoid strenuous activity and driving for 4 to 6 weeks, or until you no longer feel pain. You can take a normal shower, but avoid baths until the surgical wound heals. When resting, place a pillow under your leg.

Your doctor will tell you when to come back for a checkup and when to resume your normal activities.

Tibioperoneal Bypass

What is a Tibioperoneal bypass?
Tibioperoneal bypass is a surgical procedure performed to reroute blood around blocked or damaged tibial arteries. These are the arteries in the lower part of the leg. Two tibial arteries go through each leg. Tibioperoneal bypass surgery is performed when the blockage — known as atherosclerosis (hardening of the arteries) — is severe enough to damage the nerves and tissues of the legs and feet.

Who performs the surgery?
The surgery is performed by a team of medical professionals led by a vascular surgeon (a doctor who specializes in the treatment of blood vessels).

How is a Tibioperoneal bypass done?
You receive a general anesthetic and remain asleep and feel no pain during the operation.

The surgeon then removes the clamps and sews up the incision in your leg.

What are the risks?
Tibioperoneal bypass carries the same risks as any other general surgery: the possibility of infection, bleeding, and reaction to anesthesia.

If there is plaque (fatty material) in the arteries, there is an increased risk of heart attack or stroke during the operation.

A piece of blood clot may come loose and block an artery in the leg, which may mean additional surgery.

Talk with your doctor and surgeon about the risks.

How do I prepare for a Tibioperoneal bypass?
You should not eat or drink anything after midnight the night before the operation. Be sure to tell your doctor what medications you are taking, whether you have any allergies, or if you are pregnant. You should prepare for a stay in the hospital and arrange for someone to take you home.

What can I expect after the surgery?
You will stay in the hospital 2 to 4 days after the surgery. You will probably begin walking the first day after the surgery.

Your doctor will tell you when to come back for a checkup and when to resume your normal activities.

PERIPHERAL ARTERY DISEASE: NONSURGICAL TREATMENTS

Carotid Stenting

What is carotid stenting?
Carotid stenting is a nonsurgical procedure in which a tiny mesh tube called a stent is inserted into a blocked carotid artery to keep it open and to keep the blood flowing. The carotid arteries are the main arteries that carry blood to the head and brain. It is less invasive than surgery, and you recover much quicker.

Who performs the procedure?
A team of medical professionals led by a vascular surgeon (a doctor who specializes in the treatment of blood vessels) or an interventional radiologist performs the procedure.

How is carotid stenting done?
The procedure takes place in the Catheterization Lab. You wear a hospital gown. You receive a local anesthetic and a mild sedative to help you relax, and you remain awake during the procedure.

The surgeon makes a small incision over an artery in your arm. Next, the surgeon injects a dye into the artery. The dye makes it easier for the surgeon to see the artery with X-rays. Then, using real-time X-rays displayed on a video screen for guidance, the surgeon inserts a thin flexible tube called a catheter through the artery and into the blocked artery. Through the catheter, the surgeon passes the stent. A tiny balloon is placed inside the stent and inflated. The pressure from the inflated balloon opens the stent and places it in the artery. The balloon is then deflated and removed while the stent settles in the artery to keep it open and the blood flowing.

The surgeon then removes the catheter and closes the incision.

An Interventional Radiologist’s Perspective (Video 2:10)

What are the risks?
Stenting is a proven and painless procedure. As with any medical procedure, however, there is a chance of complications.

Complications include tearing of the artery wall, bruising or bleeding at the site where the catheter is inserted, and allergic reaction to the dye used with the X-ray. People with kidney disease or diabetes may have a higher risk of complications from the dye.

A piece of blood clot may come loose and block an artery, which can lead to a stroke.

On rare occasions, the carotid artery may become blocked again.

Talk with your doctor and surgeon about the risks.

How do I prepare for carotid stenting?
You should not eat or drink anything for four hours before the procedure. Be sure to tell your doctor what medications you are taking, whether you have any allergies, or if you are pregnant. You should prepare for an overnight stay in the hospital and arrange for someone to take you home.

What happens after the procedure?
After the procedure, you will be moved to a recovery room, where you will rest for several hours while staff monitors your condition. You will then be moved to a regular room, where you will spend at least one night.

Once your return home, you should drink plenty of water for 2 days to help flush out the dye used for the X-ray. You should be able to resume your normal activities after several days.

Angioplasty for Peripheral Artery Disease of the Legs

What is angioplasty for peripheral artery disease of the legs?
Angioplasty — also called balloon angioplasty — is a general term for a nonsurgical procedure in which a balloon is used to open narrowed or blocked veins and arteries. When used to open arteries in the legs, it is more specifically called angioplasty for peripheral artery disease of the legs. It is less invasive than surgery and you recover much quicker.

How is angioplasty for peripheral artery disease of the legs done?
The procedure takes place in the Catheterization Lab. You wear a hospital gown. You receive a local anesthetic and a mild sedative to help you relax, and you remain awake during the procedure.

The surgeon makes a small incision in your leg near the area where the artery is blocked. Next, the surgeon injects a dye into the artery. The dye makes it easier for the surgeon to see the artery with X-rays. Then, using real-time X-rays displayed on a video screen for guidance, the surgeon inserts a thin flexible tube called a catheter into the artery to the exact spot where it is blocked. At the end of the catheter is a tiny balloon. The surgeon inflates the balloon for 20 seconds to 3 minutes. The inflated balloon pushes the fatty material blocking the artery against the wall of the artery. This opens the artery and improves blood flow.

The surgeon then deflates and removes the balloon and closes the incision.

What are the risks?
Angioplasty is a proven and painless procedure. As with any medical procedure, however, there is a chance of complications.

Complications include rupture of the artery, bruising or bleeding at the site where the catheter is inserted, and allergic reaction to the dye used with the X-ray. People with kidney disease or diabetes may have a higher risk of complications from the dye.

Because the arteries of the leg are so small, there is chance the arteries may become blocked again within a year.

Talk with your doctor and surgeon about the risks.

How do I prepare for angioplasty for peripheral artery disease of the legs?
You should not eat or drink anything for four hours before the procedure. Be sure to tell your doctor what medications you are taking, whether you have any allergies, or if you are pregnant. You should prepare for an overnight stay in the hospital and arrange for someone to take you home.

Once your return home, you should drink plenty of water for 2 days to help flush out the dye used for the X-ray. You should be able to resume your normal activities after several days.

Renal Artery Angioplasty with Stent

What is renal artery angioplasty with stent?
Renal artery angioplasty with stent is a nonsurgical procedure in which a tiny mesh tube called a stent is inserted into a blocked renal artery to keep it open and to keep the blood flowing. The renal arteries carry blood to the kidneys. The procedure is less invasive than surgery, and you recover much quicker.

How is renal artery angioplasty with stent done?
The procedure takes place in the Catheterization Lab. You wear a hospital gown. You receive a local anesthetic and a mild sedative to help you relax, and you remain awake during the procedure.

The surgeon makes a small incision over an artery at your groin. Next, the surgeon injects a dye into the artery. The dye makes it easier for the surgeon to see the artery with X-rays. Then, using real-time X-rays displayed on a video screen for guidance, the surgeon inserts a thin flexible tube called a catheter into the artery and into the blocked renal artery. Through the catheter, the surgeon passes the stent. A tiny balloon is placed inside the stent and inflated. The pressure from the inflated balloon opens the stent and places it in the artery. The balloon is then deflated and removed while the stent settles in the artery to keep it open and the blood flowing.

The surgeon then removes the catheter and closes the incision.

What are the risks?
Angioplasty with stent is a proven and painless procedure. As with any medical procedure, however, there is a chance of complications.

A piece of blood clot may come loose and block an artery, which can lead to a stroke.

On rare occasions, the renal artery may become blocked again.

Talk with your doctor and surgeon about the risks.

How do I prepare for renal artery angioplasty with stent?
You should not eat or drink anything for four hours before the procedure. Be sure to tell your doctor what medications you are taking, whether you have any allergies, or if you are pregnant. You should prepare for an overnight stay in the hospital and arrange for someone to take you home.

Once your return home, you should drink plenty of water for 2 days to help flush out the dye used for the X-ray. You should be able to resume your normal activities after several days.

Abdominal Aortic Stent Graft

What is an abdominal aortic stent graft?
An abdominal aortic stent graft — also called endovascular repair of abdominal aortic aneurysms — is a nonsurgical procedure in which a tiny tube called a stent graft is inserted in an aneurysm (bulge) in the aorta. The aorta is the main artery that carries blood from the heart to the rest of the body. The stent graft creates a bypass through the aneurysm that allows blood to flow while taking pressure off the wall of the aneurysm. The procedure is less invasive than surgery, and you recover much quicker.

Who performs the procedure?
The surgery is performed by a team of medical professionals led by a vascular surgeon (a doctor who specializes in the treatment of blood vessels) or an interventional radiologist.

How is an abdominal aortic stent graft done?
The procedure takes place in the Catheterization Lab. You wear a hospital gown. You receive a local anesthetic and a mild sedative to help you relax, and you remain awake during the procedure.

The surgeon makes a small incision over an artery at your groin. Next, the surgeon injects a dye into the artery. The dye makes it easier for the surgeon to see the arteries with X-rays. Then, using real-time X-rays displayed on a video screen for guidance, the surgeon inserts a thin flexible tube called a catheter through the artery and into the abdominal aorta. Through the catheter, the surgeon passes the stent graft and places it inside the aneurysm where it expands and settles into place. Blood then flows through the stent graft, taking pressure off the aneurysm.

The surgeon then removes the catheter and closes the incision.

What are the risks?
Abdominal aortic stent graft is a proven and painless procedure. As with any medical procedure, however, there is a chance of complications.

Because the stent graft can move, there is a chance that the aneurysm may reappear.

Talk with your doctor and surgeon about the risks.

How do I prepare for an abdominal aortic stent graft?
You should not eat or drink anything for four hours before the procedure. Be sure to tell your doctor what medications you are taking, whether you have any allergies, or if you are pregnant. You should prepare for an overnight stay in the hospital and arrange for someone to take you home.

Once your return home, you should drink plenty of water for 2 days to help flush out the dye used for the X-ray. You should be able to resume your normal activities after several days.

Because there is the chance the aneurysm may reappear, your doctor will schedule you for checkups at least twice a year.

Oregon Heart & Vascular Institute
In Affiliation With Sacred Heart Medical Center
3311 RiverBend Drive, Springfield, OR 97477
email or phone: (541) 222-7218 or (888) 240-6484