The causes of a blocked leg artery are numerous. These include blockage stemming from longstanding peripheral arterial disease, blockage related to a blood clot traveling from a different location, trauma-related blockage and blockage caused by compression from nearby anatomic structures. Blockages are categorized by the onset of symptoms. Acute blockages occur suddenly and symptoms appear rapidly. Chronic blockages develop over time, which allows for gradual symptom appearance. Treatment is tailored to both the cause and duration of the blockage.
Conservative Therapy
Conservative, or non-invasive, medical therapy is the first line in managing chronically blocked leg arteries. While medical management cannot open a chronically occluded artery, it can slow or even halt the progression of underlying peripheral arterial disease. Components of conservative therapy include smoking cessation, blood pressure control, cholesterol lowering medication, blood sugar control and anti-platelet medication.
Surgical Bypass
Surgical bypass is a treatment option for both acute and chronic blockages. This is an open operative procedure, requiring general anesthesia and several days of hospitalization for recovery. This operation involves suturing a new vascular conduit above and below the blockage, effectively bypassing the occlusion. The surgical conduit can consist of synthetic graft material or the patient's own vein harvested from a different part of the body.
Percutaneous Revascularization
Percutaneous revascularization is a novel, minimally-invasive method of reopening a blocked leg artery. The procedure involves only a small incision and is commonly performed on an outpatient basis without the need for general anesthesia. Real-time x-ray imaging provides guidance for the procedure, which uses catheters and wires to pass through a blockage from within the artery itself. Angioplasty balloons and vascular stents are subsequently used to restore the artery to its native diameter.
Catheter-Directed Thrombolysis
Catheter-directed thrombolysis is used to treat acutely blocked leg arteries caused by a blood clot. This technique, similar to percutaneous revascularization, uses x-ray guidance and a small incision. A catheter with multiple small holes along its length is advanced over a wire through the clotted portion of the blood vessel. Once positioned, medication is administered directly into the clot, causing it to dissolve.
Embolectomy
Embolectomy is a surgical alternative to catheter-directed thrombolyis in treating acutely clotted leg arteries. This technique involves making an incision directly into the affected artery and physically removing the thrombus.
References
- "Journal of Vascular and Interventional Radiology"; Medical treatment of peripheral arterial disease: A comprehensive review; A Stoyioglou et al.; November 2004
- "Journal of Vascular Surgery"; Inter-society consensus for the management of peripheral arterial disease; L Norgren et al.; June 2007
