More Treatments for Poor Circulation

For a small number of patients, the medications aren't enough, and other treatments may be necessary. Angioplasty, stent placement, or clot-removal treatments are nonsurgical and are performed by making a small cut through which a catheter is inserted to reach the blocked artery. A tiny balloon is inflated inside the artery to open the clog.

The procedure requires only a local anesthetic, and patients can return to normal activity in 24 to 48 hours. Complication rates are low. The effects are not permanent, but the procedure can be repeated without any greater risk. A stent (a tiny wire mesh cylinder) could be implanted at this time to help hold the artery open. Sometimes a medicine can be given through the catheter or a special device can be placed to remove a clot that is blocking the artery.

Because of the risk that a vein may reclose from blood clots after the operation, various other procedures are being used and others being investigated, including using stents, brachytherapy, lasers, and cryoplasty therapy. Radioactive implants (brachytherapy) helps prevent the arteries from closing after angioplasty.

In a major 2002 analysis, it produced greater benefits than angioplasty alone, at least in the short term. Lasers are also being investigated: light pulses are used to remove cholesterol plaques and blood clots from the blood vessels. A 2004 report suggested that laser therapy may be particularly useful in PAD patients who are not good candidates for bypass surgery.

A new type of angioplasty called PolarCath (cryoplasty therapy) opens blocked arteries by cooling and dilating them with a nitrous oxide-filled balloon. A 2004 study showed that this procedure has a nine-month failure rate of less than 20%, which is significantly lower the 40%-50% failure rate reported after angioplasty or stenting procedures.

If a long portion of artery in the leg is completely blocked, and the patient is having severe symptoms, surgery may be necessary. A vein can be taken from another part of the body to “bypass” and reroute blood around the closed artery. Artificial veins have a much a higher risk of blood clots, and consequences of re-obstruction are much more severe than when a natural vein recloses. To keep artificial veins open, certain anti-clotting agents, such as aspirin or warfarin, may be used, but these are ineffective with natural veins.

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