Peripheral arterial disease

Information about circulation:

Blood is pumped through the arteries from the heart to the body, blood then returns to the heart through the veins. Arteries are particularly important because as we age, we can experience disease or injury that can result in blockages or narrowing of the arteries.

When these blockages cause symptoms or problems, sometimes surgery is required to correct or re-open arteries in the body. This can be done in many ways, but the two main ways are with endovascular or open procedures.

Endovascular procedures – angioplasty (balloon treatments) or stenting

Dr Morrisroe uses minimally invasive techniques wherever possible. Balloons and stents are medical devices used to help improve blood flow through arteries that have become narrowed or blocked by the build-up of plaque (fatty deposits) inside the arteries.

Endovascular Procedures

The balloon procedure is referred to as “angioplasty” or percutaneous transluminal angioplasty. It is a procedure to re-open or improve the blood flow within an artery. The procedure is carried out in a special operating room with X-ray guidance. Dr Morrisroe generally performs these procedures under local anaesthetic, with or without sedation (the patient remains awake, but without feeling pain). Patients go home the same day, and generally feel the improvement from the procedure very shortly thereafter.

In most cases, endovascular procedures are performed as a ‘percutaneous’ approach (no large cut, and no stitches). After making a small needle hole to enter the artery, a thin wire and tube (catheter) are inserted. Angiograms (pictures of the flow within the arteries) are used to find the narrowing or blockages.  Then the wire can pass through the area to allow treatment. The (uninflated) balloon is then maneuvered over the wire through the blocked or narrowed section. Once this has been safely undertaken, the balloon can be inflated, then deflated and removed. The result is that the artery is “stretched” back open.  In the event that the artery seems to re-narrow very quickly, or not open up all the way, there is an option to place a “stent”.

A stent is a very small expandable metal mesh tube, which may or may not have a covering over it. The stent is expanded into position, and it remains in place, even when the balloon and catheter are removed. A stent may help to stop the blood vessel from re-narrowing.

Left: Uninflated stent in position. Right: Inflated stent prior to removal of the balloon.

The above endovascular treatments have been used for decades. There are some patterns of disease where endovascular is the best option, but other patterns of disease where open surgery may be the best treatment. Dr Morrisroe will discuss the options specific to your pattern of disease at your consultation with her.

Open procedures – endarterectomy or bypass

Endarterectomy –

In the event that you have a short or focal severe narrowing or blockage, for example in the common femoral artery, this may be best treated with endarterectomy. This process essentially “cleans out” the diseased artery. It would involve an open cut-down onto the artery, removing the bulky disease, and usually patching your artery back up after the clean out (using either your own vein or a bovine pericardium patch).

Open Bypass Surgery –

Although endovascular procedures are very effective, sometimes treatment with balloons or stents are not possible to treat your individual disease process. Open bypass surgery is an alternative for people who are suffering from narrowing or blockages of the arteries, especially when it is a long blockage or when endovascular treatment has failed. Open bypass surgery has been undertaken for over 70 years. There is very good information on the long-term patient results and outcomes available for this procedure and this can guide us on management.

Open bypass surgery is more accurately named by the vessels you are bypassing to or from. For example, from the groin artery all the way to the below knee artery would be called a femoral to popliteal bypass. This is one of the most common bypasses we undertake. Essentially, a bypass allows a tube / graft to plug onto your healthy artery above and below the blockage – thus creating a new artery (or “bypassing” the blockage). The most common “graft” that Dr Morrisroe uses is your own vein from the same leg. We have superficial veins which we do not necessarily need and these can be re-purposed as a new artery. There are lots of advantages to using your own tissue rather than a prosthetic or plastic tube. A bypass graft is performed under a general anesthetic most of the time, and on average takes 2-3 hours to complete. After the surgery, a hospital stay of 5-7 days is generally necessary. This is so that we can ensure that you are comfortable and safe with your walking before you go home.