Revascularisation surgery

Question 1

What are the two types of revascularisation surgery?

Answer 1

Angioplasty
Bypass graft surgery

Question 2

What are the two revascularisation treatment options for PAD?

Answer 2

Endovascular revascularisation

• balloon angioplasty or stent placement
• used for short segment disease <10cm or aortic iliac disease
• suitable for high risk patients

Surgical revascularisation

• autologous vein or prosthetic material used
• endarterectomy (removal of plaque from the vessel)
• used for long segment lesions (>10cm) or multifocal regions

Amputation reserved for those not suitable for any intervention.

Question 3

What are the indications for revascularisation surgery in PAD?

Answer 3

• Disabling claudication
• Critical limb ischaemia
• Weak or absent femoral pulses

Question 4

What is the major disadvantage of endovascular interventions over bypass surgery in PAD?

Answer 4

Long-term patency is not as good in endovascular procedures
Cannot be used in multifocal lesions, very small diameter vessels <8mm, or vessels with aneurysmal dilatation

BUT: surgical has higher morbidity and mortality

Question 5

What are the complications of revarscularisation for PAD?

Answer 5

Distal embolisation e.g. blue toe syndrome
Endovascular repair:

• Vessel rupture
• Dissection
• Early/late occlusion
• Loss of branch vessels
• Distal embolisation e.g. blue toe syndrome
• Restenosis

Surgical:

• Surgical site infection
• Graft failure -> limb loss
• MI/arrhythmias
• Sudden cardiac death
• Acute renal failure
• Wound complications e.g. haematoma formation, wound Infection, wound dehiscence