The most common disease that I treat as a vascular surgeon is a medical problem called peripheral vascular disease. Specifically, peripheral refers to the legs, and vascular disease refers to blockages of the arteries.
Because peripheral vascular disease is the most common disease that I treat, I want to talk today about what I can do as a vascular surgeon to fix these kinds of blockages in the arteries!
First though, let me explain why blockages to the arteries of the legs are bad. When not enough blood flow reaches the legs, patients can have pain in their calves or buttocks that limits their ability to walk longer than a city block. When the blockages are very severe, they can also have pain in their feet and toes even when they are not moving or develop non-healing ulcers and gangrene. When I open blockages in patients’ legs, I allow them to walk again, or I give them the ability to heal their ulcers and gangrene pain free. The improvement in patient lives is the most exciting aspect of my job!
There are two main approaches to performing what we call revascularization. Revascularization refers to the opening of old passageways or creation of new passageways to bring blood directly from the heart to the foot without any obstruction.
- Open Surgery: In the early decades of vascular surgery, namely the 1980s and 1990s the primary way to treat peripheral vascular disease was to perform an open surgical bypass. If there was a blockage in the thigh, I would surgically expose above and below the blockage and take a synthetic tube or the patient’s own vein and then sew it above and below the blockage. This would allow the flow of blood to bypass the blocked segment, hence, the reason we call this surgery a bypass! Though this procedure does produce robust flow, it necessitates large surgical incisions that cause significant pain and are susceptible to poor wound healing and/or infection.
- Endovascular Surgery: In the 2000s, an innovative approach called endovascular surgery started to become more widely used and is now actually standard of care today. Indeed, I prefer to treat patients with peripheral vascular disease with endovascular surgery whenever possible. We access the arterial system of the leg with a needle in the groin. Through that needle we put in a strong wire and over that wire we can then advance several different instruments over catheters. In general, there are three different techniques I can employ in my efforts to re-establish blood flow to an area that is no longer receiving blood due to some type of arterial blockage.
- Balloons: The most basic instrument is a balloon that expands and breaks up the narrowing or blockage.
- Stents: If the balloon does not work, we can use a self-expanding tube called a stent.
- Atherectomy: If the stent does not work, we can use a special device called atherectomy. Atherectomy involves the use of a device that can literally cut the plaque out of the artery and aspirate all the debris.
These three technologies allow the reopening of arteries from the toes to the pelvis and only necessitate a 2 mm puncture site in the skin of the groin to be used. There is little to no risk of infection and the procedure can be performed several times over the course of the patient’s life. On the other hand, surgical bypass can only be performed twice—three times—during the patient’s life due to the development of dense scar tissue after each operation.
If you have trouble walking because of pain in your buttocks or calves or have pain in your feet and toes or ulcers that will not heal, please do not hesitate to call my office today at 408-376-3626 to schedule an appointment. The chances are that I will be able to help take your pain and ulcers away! We Can Help