Minimally invasive procedures

To directly address the narrowing of the arteries, invasive measures are possible. These are divided into catheter procedures and surgical procedures. Different procedures are possible in each case, depending on the degree and length of the constriction: Catheter procedures are used from stage IIb onwards.

In the various procedures, a catheter is almost always inserted into the narrowed vessel from the groin. The vessel is made visible by the administration of contrast medium and then different methods are used:

In the standard PTA (percutaneous transluminal angioplasty) procedure, a so-called guide wire is advanced through the artery into the narrowed area. An inflatable balloon catheter is then inserted over this guide wire into the constriction and inflated.
This causes the vessel to dilate. To prevent a further constriction at this point, a vessel support is inserted (stent implantation). However, this procedure is only suitable for short-distance constrictions or occlusions up to 10cm. PTA is also not appropriate in cases of excessive calcification.
Special procedures are available for longer-distance constrictions. In laser, rotational or ultrasound angioplasty, the calcifications of the artery walls are removed by laser, drill head or ultrasound.
Other combinations of drug delivery to dissolve closures, suction and PTA are possible.

Operation

The operative measures depend on the stage of the PAD and the degree and length of the stenosis: As medicine is subject to constant change, new therapies are constantly being sought. There are also some experimental therapies for pAVK, but these are only carried out within the framework of clinical studies. This is of course only carried out after a detailed examination has taken place.

Gene therapies are currently being tested. For example, certain growth factors (VEGF, rFGF-2) are being used to stimulate vascular growth. Therapies with bone marrow stem cells are also being tested.

These methods are intended to stimulate the growth of vessels and also to form new vessels.

If vasoconstrictions are present in the large pelvic and femoral arteries (A. iliaca and A. femoralis), an attempt can be made to peel out the vessels. This is called desobliteration or thrombendarterectomy (TEA).
In this procedure, for example, the calcification and the inner part of the vessel wall (the intima) are cut out with the help of a so-called ring stripper.
In stage III and IV it may be necessary to place a bypass. There are numerous possibilities. In the case of occlusions in the thigh or lower leg, the “great rose vein“, V. saphena magna, is usually removed to serve as a replacement.
It belongs to the superficial veins and runs from the foot in front of the inner ankle via the inner side of the thigh to the groin.Since it is one of the superficial veins responsible for only 10% of the blood return, it can be removed without major restrictions. It is also possible to use foreign material instead. This is usually Teflon (PTFE, polytetrafluoroethylene).

However, this material is only used when the aorta and the pelvic vessels are narrowed, since a larger vessel caliber is required. However, not all vessel occlusions can be operated on. In the worst case, the blood supply may be so restricted that the extremity dies. In this case, the only remaining option (so-called ultima ratio) is amputation. However, before such an extreme measure is proposed, all other procedures will be thoroughly examined.