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Surgical procedures generally aim to restore blood flow using techniques that directly expose one or more blood vessels (open surgery). Having direct and open control of the blood vessel allows for a number of procedures to be performed. Some surgical procedures involve both open surgical and endovascular techniques. In general, surgical procedures carry higher risk and longer recoveries but, in some cases, may offer better and longer-lasting outcomes than endovascular procedures. These include:
- Endarterectomy. The removal of atherosclerotic plaque from a blood vessel to allow better blood flow through a blocked artery. This is one of the oldest techniques for repairing blood vessels and continues to be used either alone or in combination with other procedures for a large number of patients with peripheral arterial disease (PAD). During this procedure, the atherosclerotic plaque is peeled out of the artery. Once the plaque is removed, the resulting vessel is larger than its original size.
- Bypass surgery. This refers to the “rerouting” of blood through a new pathway or bypass graft. A bypass graft that is harvested from the patient’s body is referred to as an autologous conduit or autologous graft. It is almost always a vein taken from the leg but can be an artery. A bypass graft made from an artificial substance, usually polyester or an expanded form of Teflon, is referred to as a prosthetic graft. The graft is sewn to a blood vessel that has a good blood supply and then routed to a normal blood vessel past the blockage. This restores normal blood pressure to the affected leg past the area of the blocked artery.
- Gene therapy. An experimental treatment for a variety of different medical conditions. The concept is to introduce cells, or harmless viruses that transport healthy genes, into organs or areas of the body that contain defective or missing DNA. One area of gene therapy is stem cell research. Stem cells are immature cells, meaning they have the ability to develop into a variety of mature cells, such as red or white blood cells, platelets, heart muscle cells, brain cells, etc. Recent studies have reported encouraging findings using stem cells taken from a patient’s own bone marrow. Bone marrow cells are seen to enhance the formation of blood vessels and rebuilding of muscle. Researchers find that bone marrow implanted into the leg can reverse claudication associated with PAD.
Vascular surgeons, interventional cardiologists or radiologists who have been specifically trained in each treatment area may conduct these procedures.
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