The most important therapeutic modalities include:
- Percutaneous transluminal angioplasty (PTA or balloon dilatation): A catheter to which a small balloon is attached is introduced through the femoral artery into the narrowed vessel under local anesthesia. The balloon then unfolds by addition of fluid and dilates the narrow segment (calcification is pressed firmly into the arterial wall). This results in improvement of blood flow. This minimally invasive procedure is performed in hospital which enables immediate treatment of complications, if any, but the duration of hospitalization required is usually brief.
- Stent implantation: A small tube (or stent) is frequently inserted into the vessel after balloon dilatation, which serves as a “support” and stabilizes the vessel. This helps prevent re-occlusion of the artery.
It must be noted that a vessel may re-occlude even after it has been dilated. You must therefore be regularly followed up by your physician to enable early identification of arterial re-occlusion.
- Open surgery: Balloon dilatation and stent implantation are not feasible if arteries are completely or near-completely occluded. Open surgery is required in such cases and is performed under general anesthesia. A variety of surgical procedures may be performed for treatment of intestinal and renal arteries, the most common being bypass surgery or thrombendarterectomy.
- Bypass surgery: An occluded vessel is bridged during this procedure- either with a natural vascular segment from another part of the body, or with an artificial vascular prosthesis. This creates a kind of “diversion” around the narrowed segment.
- Thrombendarterectomy: Branches from the main artery are exposed and calcium deposits are then “peeled off” from their walls. Vascular function is adequately maintained by the remaining wall layers. This operation is usually combined with a “patch plasty”. This is a patch obtained from the patient’s own vein or made of plastic which is sewn into the vessel to prevent subsequent narrowing due to scarring of the vessel wall.