The surgical approach to vascular disease is intended to either open up diseased arteries or to bypass them with new ones. An open surgical procedure ( endarterectomy or bypass grafting ) is the traditional approach.

Less invasive techniques, such as percutaneous angioplasty , use long, thin instruments that are passed through blood vessels. This approach is gaining in popularity.

Endarterectomy and Bypass Grafting

Depending on where and how severe the blockage is, the vascular surgeon has two choices:

  • Clean out the artery by removing the diseased inner lining (endarterectomy)
  • Hook a bypass to a healthy section above and a healthy section below the diseased portion (bypass grafting)

Bypasses can be constructed from artificial Dacron tubing or a vein taken from your leg or some other convenient location.

Percutaneous Angioplasty

This procedure allows doctors to approach your diseased arteries from the inside via "real time" x-rays and high-tech instruments. These instruments can be passed through your blood vessels. Starting with an easily accessed artery—most likely in the groin—the doctor will thread long, thin instruments into the vessel under x-ray guidance until it reaches the problem area. There, several possible techniques can be used to open up the diseased or clogged part of the artery.

Once the instruments have reached the target site, the physician may elect to insert a tapered dilator or balloon into the narrowing to stretch it out. Alternatively, a laser may be used to burn through the plaque and open up the artery. Other alternatives include injecting clot dissolving chemicals directly into the blocked artery or removing a clot with special instruments. A rigid "stent" may be inserted to keep the artery open.

Balloon Angioplasty

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