For certain types of PAD, balloon angioplasty alone is effective at opening the arteries. In certain situations, doctors will also implant a small wire mesh tube called a stent to prevent re-narrowing after the artery has been opened with a balloon. In deciding whether a stent is needed, doctors will consider the location and size of your artery narrowing or blockages, and how likely they are to re-narrow in the future.
If you have PAD in your thigh arteries or further down in your legs, balloon angioplasty alone is often enough to restore blood flow and relieve your PAD symptoms. In most cases, stents will only be used to treat these arteries if angioplasty failed to open the artery completely, or if the arteries have re-narrowed after an earlier treatment.
If you have blockages in the iliac arteries, large arteries in the lower abdomen that carry blood to each leg, you will probably have a stent implanted after angioplasty is performed (during the same procedure).1
Should I have angioplasty and stenting or surgery to treat PAD?
The main alternative to angioplasty and stenting for PAD in the legs is peripheral artery bypass surgery. In this surgical procedure, a healthy vessel from elsewhere in the body is removed and re-attached to direct blood flow around the blockage. Bypass surgery was once the standard procedure to treat PAD, but today angioplasty is much more common.7
Before you have a procedure, tests such as ultrasound, MR angiography, CT angiography, or a contrast angiogram will be performed to examine your artery blockages and decide on the best treatment. For most women, endovascular treatments are the first choice because they are as effective as surgery for many blockages, with fewer risks and a shorter recovery time.1
Some blockages are too long or in a difficult location to treat with endovascular techniques, in which case bypass surgery may be your best option. Surgery may also be required if you already had angioplasty or a stent procedure that failed to restore blood flow and improve your PAD symptoms. Peripheral artery bypass surgery may be necessary if you have severe PAD that is causing tissue in your legs to die (critical limb ischemia), risking amputation if blood flow is not restored.