An estimated 8 million Americans are affected by peripheral arterial disease, also known as peripheral artery disease (PAD). This condition can cause leg discomfort when walking or more serious problems such as pain in the foot at rest, toe ulcers, toe infections and gangrene. The South Arkansas Cardiology vascular and endovascular team is dedicated to optimizing the patient’s vascular health, not just treating arterial blockages. Our team develops a personalized treatment plan for each patient diagnosed with PAD.

Non-Invasive Services

PAD Evaluation

Overview

Peripheral artery disease (also called peripheral arterial disease) is a common circulatory problem in which narrowed arteries reduce blood flow to your limbs.

When you develop peripheral artery disease (PAD), your extremities — usually your legs — don’t receive enough blood flow to keep up with demand. This causes symptoms, most notably leg pain when walking (claudication).

Peripheral artery disease is also likely to be a sign of a more widespread accumulation of fatty deposits in your arteries (atherosclerosis). This condition may be reducing blood flow to your heart and brain, as well as your legs.
You often can successfully treat peripheral artery disease by quitting tobacco, exercising and eating a healthy diet.

Symptoms

While many people with peripheral artery disease have mild or no symptoms, some people have leg pain when walking (claudication).

Claudication symptoms include muscle pain or cramping in your legs or arms that’s triggered by activity, such as walking, but disappears after a few minutes of rest. The location of the pain depends on the location of the clogged or narrowed artery. Calf pain is the most common location.

The severity of claudication varies widely, from mild discomfort to debilitating pain. Severe claudication can make it hard for you to walk or do other types of physical activity.

Peripheral artery disease signs and symptoms include:

• Painful cramping in one or both of your hips, thighs or calf muscles after certain activities, such as walking or climbing stairs (claudication)
• Leg numbness or weakness
• Coldness in your lower leg or foot, especially when compared with the other side
• Sores on your toes, feet or legs that won’t heal
• A change in the color of your legs
• Hair loss or slower hair growth on your feet and legs
• Slower growth of your toenails
• Shiny skin on your legs
• No pulse or a weak pulse in your legs or feet
• Erectile dysfunction in men

If peripheral artery disease progresses, pain may even occur when you’re at rest or when you’re lying down (ischemic rest pain). It may be intense enough to disrupt sleep. Hanging your legs over the edge of your bed or walking around your room may temporarily relieve the pain.

When to see a doctor

If you have leg pain, numbness or other symptoms, don’t dismiss them as a normal part of aging. Call your doctor and make an appointment.

Even if you don’t have symptoms of peripheral artery disease, you may need to be screened if you are:

• Over age 65
• Over age 50 and have a history of diabetes or smoking
• Under age 50, but have diabetes and other peripheral artery disease risk factors, such as obesity or high blood pressure

Causes

Peripheral artery disease is often caused by atherosclerosis. In atherosclerosis, fatty deposits (plaques) build up on your artery walls and reduce blood flow.

Although discussions of atherosclerosis usually focus on the heart, the disease can and usually does affect arteries throughout your body. When it occurs in the arteries supplying blood to your limbs, it causes peripheral artery disease.

Less commonly, the cause of peripheral artery disease may be blood vessel inflammation, injury to your limbs, unusual anatomy of your ligaments or muscles, or radiation exposure.

Risk factors

Factors that increase your risk of developing peripheral artery disease include:

• Smoking
• Diabetes
• Obesity (a body mass index over 30)
• High blood pressure
• High cholesterol
• Increasing age, especially after reaching 50 years of age
• A family history of peripheral artery disease, heart disease or stroke
• High levels of homocysteine, a protein component that helps build and maintain tissue

People who smoke or have diabetes have the greatest risk of developing peripheral artery disease due to reduced blood flow.

Complications

If your peripheral artery disease is caused by a buildup of plaques in your blood vessels (atherosclerosis), you’re also at risk of developing:

• Critical limb ischemia. This condition begins as open sores that don’t heal, an injury, or an infection of your feet or legs. Critical limb ischemia occurs when such injuries or infections progress and cause tissue death (gangrene), sometimes requiring amputation of the affected limb.
• Stroke and heart attack. The atherosclerosis that causes the signs and symptoms of peripheral artery disease isn’t limited to your legs. Fat deposits also build up in arteries supplying blood to your heart and brain.

Prevention

The best way to prevent claudication is to maintain a healthy lifestyle. That means:

• Quit smoking if you’re a smoker.
• If you have diabetes, keep your blood sugar in good control.
• Exercise regularly. Aim for 30 to 45 minutes several times a week after you’ve gotten your doctor’s OK.
• Lower your cholesterol and blood pressure levels, if applicable.
• Eat foods that are low in saturated fat.
• Maintain a healthy weight.

ABI/PVR

What is a Pulse Volume Recording (PVR) study?

A PVR study is a noninvasive vascular test often done in conjunction with an ankle brachial index (ABI) to detect blockages in the legs.

What is an ABI/PVR?

The ABI is a measurement of the blood pressure in the lower leg compared to the blood pressure in the arm. Your physician will compare the two numbers to determine your ABI. Normally, the blood pressures in your ankle and arm should be about equal. But if your ankle pressure is lower than your arm pressure, it could be a sign that your leg arteries are narrowed.
The PVR is a test which uses blood pressure cuffs and a hand held ultrasound device (Doppler) to obtain information about the arterial blood flow in the arms and lefts.
The blood pressure cuffs are placed on the arm and leg and inflated, while the Doppler is used to listen to the blood flow in the leg and arm.

Why do I need an ABI/PVR?

Your physician has recommended that you have this test to evaluate the blood flow in your arms and legs. This test is used to evaluate the presence of peripheral arterial disease or PAD.

What should I expect during the PVR test?

There is no preparation for the test. You will be asked to wear shorts and a short sleeve shirt for the test and you will be required to remove your shoes and socks. Blood pressure cuffs will be applied to your arms and legs and at various times will be inflated. Some patients may experience discomfort at the time of inflation. The technician will explain each step to you during the test and will stop the test if you experience increased pain. You will be able to resume your normal activities after the test is complete. The test takes approximately 45 minutes.

Carotid Duplex Ultrasound

Ultrasound is a study that uses sound waves to “see” inside your body. A carotid duplex ultrasound is performed to evaluate symptoms including dizziness, loss of memory, stroke, loss of muscle control and other symptoms that might result from narrowing or blockage of the vessels (carotid arteries) on either side of your neck. A carotid ultrasound can also be used to screen for stroke risk. At the S. Mark Taper Foundation Imaging Center, we have a specialized team of physicians, nurses, and technologists who are experts in ultrasound radiology.

Before Your Exam

There is no preparation for this procedure.
If your doctor gave you an order, please bring it with you.
You may want to wear loose clothing for this procedure, especially at the neck. It is best not to wear turtlenecks or silk shirts (because of the gel that will be used).
We want to make your waiting time as pleasant as possible. Please consider bringing your favorite magazine, book or music player to help you pass the time.
Please leave your jewelry and valuables at home.

During Your Exam

The vascular technologist will explain your exam and answer any questions you may have.
Your procedure may be performed with you lying on the examination table or sitting in a chair.
The technologist will apply warm gel to your neck area.
A transducer, a small, microphone-like device, will be placed over each side of your neck.
You will not feel any pain; however you will feel mild pressure from the transducer.
Sound waves will bounce off the organs and tissue in your body and the blood moving in your arteries. This creates “echoes.” The echoes are reflected back to the transducer. A television monitor shows images as the transducer converts the echoes to electronic signals. These images may be viewed immediately, or photographed for further study.
You may hear unusual sounds as the technologist views and records the blood flowing through your neck vessels (carotid arteries).
Your exam will take approximately 15 to 30 minutes.

After Your Exam

Your study will be reviewed by a vascular surgeon and the results sent to your physician.

Arterial Duplex Ultrasound

Ultrasound is a procedure that uses sound waves to “see” inside your body. An arterial duplex ultrasound uses sound waves to create a color map of the arteries in your legs to identify:

• Narrowing of your vessels that may be causing leg pain when walking
• Resting leg pain
• Foot, ankle, heel -or toe ulcers
• Skin discoloration

At the S. Mark Taper Foundation Imaging Center, we have an expert team of physicians, nurses and technologists who are highly trained in ultrasound imaging.

Before Your Exam

There is no preparation for this procedure.
If your doctor gave you an order, please bring it with you.
We want to make your waiting time as pleasant as possible. Please consider bringing your favorite magazine, book or music player to help you pass any time you have to wait.
Please leave your jewelry and valuables at home.

Above: an arterial duplex ultrasound showing blood flow in the right femoral artery in the leg.

During Your Exam

The vascular technologist will explain your exam and answer any questions you may have.

Your procedure will be performed with you lying on the examination table on your back with your hands at your sides or on your stomach.

The technologist will apply warm gel to your legs.
A transducer, a small device similar to a microphone, will be placed over various locations on your legs.

Blood pressure readings will be taken of your ankles. You will not feel any pain; however you will feel mild pressure from the blood-pressure cuff and the transducer.

Sound waves will bounce off the muscle and tissue in your body and off the blood moving in your arteries. This creates “echoes.” The echoes are reflected back to the transducer. A television monitor shows images as the transducer converts the echoes to electronic signals.

These images may be viewed immediately or photographed for further study.

You will hear unusual sounds as the technologist views and records the blood flowing through the veins and arteries in your legs.

Your exam will take approximately 60 minutes; in some cases you will be asked to do some mild exercises, which can take longer.
CTA Peripheral Angiography

What is a peripheral angiogram?

A peripheral angiogram is a test that uses X-rays and dye to help your doctor find narrowed or blocked areas in one or more of the arteries that supply blood to your legs. The test is also called a peripheral arteriogram.

Why do people have peripheral angiograms?

Doctors use a peripheral angiogram if they think blood is not flowing well in the arteries leading to your legs or, in rare cases, to your arms. The angiogram helps you and your doctor decide if a surgical procedure is needed to open the blocked arteries. Peripheral angioplasty is one such procedure. It uses a balloon catheter to open the blocked artery from the inside. A stent, a small wire mesh tube, is generally placed in the artery after angioplasty to help keep it open. Bypass surgery is another procedure. It re-routes blood around the blocked arteries.

What are the risks of peripheral angiograms?

Serious risks and complications from peripheral angiograms are very unlikely. But in rare cases:

• A thin tube (catheter) that doctors insert into your artery during a peripheral angiogram damages the artery.
• Some people may have allergic reactions to the dye used in the test. Tell your doctor if you have ever had an allergic reaction to x-ray contrast dye or to iodine substances.

How do I prepare for a peripheral angiogram?

• Your doctor will give you instructions about what you can eat or drink during the 24 hours before the test.
• Usually you’ll be asked not to eat or drink anything for 6 to 8 hours before your peripheral angiogram.
• Tell your doctor about any medicines (including over-the-counter, herbs and vitamins) you take. He or she may ask you not to take them before your test. Don’t stop taking your medicines until your doctor tells you to.
• Tell your doctor or nurse if you are allergic to anything, especially iodine, latex or rubber products, medicines like penicillin, or X-ray dye.
• Leave all of your jewelry at home.
• Arrange for someone to drive you home after your angiogram.

What happens during the peripheral angiogram?

A doctor with special training performs the test with a team of nurses and technicians. The test is performed in a hospital or outpatient clinic.

• Before the test, a nurse will put an IV (intravenous line) into a vein in your arm so you can get medicine and fluids. You’ll be awake during the test.
• A nurse will clean and shave the area where the doctor will be working. This is usually an artery in your groin.
• A local anesthetic will be given to numb the needle puncture site.
• The doctor will make a needle puncture through your skin and into your artery, and insert a long, thin tube called a catheter into the artery. You may feel some pressure, but you shouldn’t feel any pain.
• The doctor will inject a small amount of dye into the catheter. This makes the narrowed or blocked sections of your arteries show up clearly on X-rays. The dye may cause you to feel flushed or hot for a few seconds.

What happens after the peripheral angiogram?

• You will go to a recovery room for a few hours.
• To prevent bleeding, the nurse will put pressure on the puncture site. After about 45 minutes, the nurse will remove the pressure and check for bleeding.
• The nurse will ask you not to move the leg used for the catheter.
• The nurse will continue to check often for bleeding or swelling.
• Before you leave, the nurse will give you written instructions about what to do at home.

What happens after I get home?

• Drink lots of liquids to make up for what you missed while you were preparing for the angiogram and to help flush the dye from your body. For most people, this means drinking at least 6 glasses of water, juice or tea.
• You can start eating solid food and taking your regular medicines 4 to 6 hours after your angiogram.
• Don’t drive for at least 24 hours.
• The puncture site may be tender for several days, but you can probably return to your normal activities the next day.
• Your doctor will get a written report of the test results to discuss with you.

What should I watch for?

A small bruise at the puncture site is common. If you start bleeding from the puncture site, lie flat and press firmly on that spot. Ask someone to call the doctor who did your peripheral angiogram.
Call your doctor if:

• Your leg with the puncture becomes numb or tingles, or your foot feels cold or turns blue.
• The area around the puncture site looks more bruised.
• The puncture site swells or fluids drain from it.

Call 911 if you notice:

• The puncture site swells up very fast.
• Bleeding from the puncture site does not slow down when you press on it firmly.

What can I do to help myself?

The most important steps you can take are:

• Quit smoking. Avoid secondhand smoke.
• Be physically active. Follow your provider’s recommendation for your appropriate level of physical activity. For most adults, walk, ride a bicycle, or do other types of moderate physical activity for at least 150 minutes per week.
• Know your blood pressure numbers. Work with your doctor to reach a blood pressure of less than 120/80 mm Hg.
• Lower your blood cholesterol levels by eating healthy foods (high in fiber and low in saturated fat and trans-fat) and taking your cholesterol lowering medicine.
• If you have diabetes, work with your doctor to keep your blood sugar under control and reach and maintain an HbA1c of less than 7 percent. HbA1c (hemoglobin A1c) is a blood test that measures your average blood sugar level for the previous 2 to 3 months.
• If you are overweight, set your initial goal at a loss of 5 to 10 pounds. If you need to lose more, a weight loss of 1 to 2 pounds per week is recommended until you reach a healthy weight. Visit our Losing Weight section for more information.
• If you drink alcohol, have only 1 drink a day if you’re a woman, 2 if you’re a man. Learn more about alcohol and heart disease.

Invasive Services

Upper & Lower Extremity Angiograms

Upper & Lower Extremity Angiography is a test used to see the arteries in the hands, arms, feet, or legs. It is also called peripheral angiography.
Angiography uses x-rays and a special dye to see inside the arteries. Arteries are blood vessels that carry blood away from the heart.

How the Test is Performed

This test is done in a hospital. You will lie on an x-ray table. You may ask for some medicine to make you sleep and relax (sedative).

• • • • • The health care provider will shave and clean an area, most often in the groin.
        • A numbing medicine (anesthetic) is injected into the skin over an artery.
        • A needle is placed into that artery.
        • A thin plastic tube called a catheter is passed through the needle into the artery. The doctor moves it into the area of the body being studied. The doctor can see live images of the area on a TV-like monitor, and uses them as a guide.
        • Dye flows through the catheter and into the arteries.
        • X-ray images are taken of the arteries.

Certain treatments can be done during this procedure. These treatments include:

• • • • • Dissolving a blood clot with medicine
        • Opening a partially blocked artery with a balloon
        • Placing a small tube called a stent into an artery to help hold it open

The health care team will check your pulse (heart rate), blood pressure, and breathing during the procedure.

The catheter is removed when the test is done. Pressure is placed on the area for 10 to 15 minutes to stop any bleeding. A bandage is then put on the wound.

The arm or leg where the needle was placed should be kept straight for 6 hours after the procedure. You should avoid strenuous activity, such as heavy lifting, for 24 to 48 hours.

Carotid Angiograms & Aortograms

A diagnostic arteriogram or aortogram is a minimally invasive test that allows a physician to map out a patient’s arteries. It provides a schematic for the physician to perform a medical procedure involving those arteries, like surgery, angioplasty, inserting a stent, and many others.

Blockage in carotid artery

Carotid angiography is an invasive imaging procedure that involves inserting a catheter into a blood vessel in the arm or leg, and guiding it to the carotid arteries with the aid of a special x-ray machine. Contrast dye is injected through the catheter so that x-ray movies of your carotid arteries (the arteries that supply your brain with oxygen-rich blood) are taken. This procedure is considered the “gold standard” for imaging the carotid and cerebral vessels.

What Is a Diagnostic Arteriogram or Aortogram Used For?

• • • • • An arteriogram or aortogram may be performed to detect any abnormalities in the blood vessels or the aorta. The most common issues are aneurysms, the narrowing of blood vessels, spasming of the blood vessels, arteriovenous malformation, thrombosis, or occlusion.
        • Any abnormal connection between arteries and veins, blockages, or clots can be detected accurately with a diagnostic arteriogram or aortogram with or without intervention.
        • Often, an arteriogram is recommended after a previous procedure that indicates a possible complication that requires more information.
        • Sometimes, if a condition is detected, the physician may intervene directly. Treatments that may be done during an arteriogram include dissolving a clot or placing a stent in a blood vessel.

Peripheral Atherectomy (Orbital and Laser)

Orbital Atherectomy

Orbital atherectomy is a promising new methodology for treating symptomatic peripheral arterial disease within the major and branch arteries of the leg. It is performed with an orbiting eccentric diamond-coated crown on the end of a drive shaft powered by a pneumatic drive console. The orbital motion of the crown removes plaque from within a diseased arterial segment; as the crown orbits, the debulking area increases, and with increments in speed, the area increases further. For comparison, rotational atherectomy uses a concentrically rotating burr, so luminal gain is as large as the burr size being utilized. Changes in rotational speed of the burr do not result in a significant increase in debulking area as happens during orbital atherectomy. If a larger lumen is desired, a larger burr must be deployed.

Orbital atherectomy is performed over a 0.014” guidewire, in contrast to a 0.009” wire with rotational atherectomy. The larger diameter guidewire makes it easier to advance across a tight stenosis. More support is given, especially when a contralateral approach is utilized or when a supportive guidewire is essential for tracking of an adjunctive device, such as a self-expanding stent delivery catheter. Also, orbital atherectomy allows continuous blood flow through stenosed (but not totally occluded) vessels, which not only continuously flushes particulate downstream but may reduce device-generated heat.

The Phoenix atherectomy system (Video) combines the benefits of existing atherectomy systems to deliver a unique, hybrid atherectomy option to help physicians tailor the treatment approach for each patient. It cuts, captures, and clears diseased tissue with one insertion. Phoenix treats a broad range of tissue types, from soft plaque to calcified arteries, and can be used for lesions above and below the knee.

Laser Atherectomy

As peripheral artery disease becomes increasingly common, vascular surgeons such as Dr. Sadeem are seeking new, less invasive and more effective ways to treat patients with PAD. Most doctors who specialize in vascular diseases use balloon expansion (angioplasty and stenting) as the principal therapy in treating lower-extremity PAD. However, Dr. Sadeem offers a viable alternative to more traditional treatment methods: laser atherectomy.

Laser atherectomy is an FDA-approved, minimally invasive endovascular technique for removing plaque from blood vessels within the body. The procedure uses a catheter that emits high-energy ultraviolet light to unblock the artery. Doctor maneuvers the catheter through the vessel until it reaches the blockage.

Dr. Sadeem uses the Spectranetics excimer laser to “photo-ablate,” or essentially vaporize, plaque, calcium deposits and another build-up inside the vessel. Once the blockage is cleared, Dallas vascular surgeon Dr. Sadeem guides a catheter through the blood vessel to restore blood flow to the peripheral tissue. Once adequate blood flow is restored, foot sores and wounds are able to heal, thus preventing the need for amputation in almost all cases.

Laser atherectomy is a minimally invasive procedure that is performed in-office and generally does not involve a hospital stay. Since only local anesthesia and a mild sedative are used, recovery time is minimal. Due to the precision of laser technology, the procedure is for most, very effective in reopening the arteries to stimulate long-term, healthy blood flow.

We invite you to watch the animations (Video 1, Video 2) to get a better idea of how laser atherectomy is performed.

Peripheral PTA & Stent

What is percutaneous transluminal angioplasty?

Percutaneous transluminal angioplasty is a minimally invasive procedure used to open a blocked artery. Your physician will follow this procedure:

• • • • • A small incision (cut) is made in the thigh, allowing access to the femoral artery.
        • A guide wire is inserted into the artery.
        • Under the guidance of X-ray video (fluoroscopy), the wire is threaded to the site of the blockage.
        • A thin tube called a catheter sheaths the wire and is pushed to the blockage. The catheter has a small, collapsed balloon at its tip.
        • The catheter enters the blockage, and the balloon is inflated, flattening the plaque against the artery walls.
        • The balloon may be coated in medicine that helps the artery heal from this process with less scarring. This is called a drug-eluting balloon.
        • Your physician then collapses the balloon and withdraws the catheter.
        • Your physician may then perform stenting and/or atherectomy.

Percutaneous Transluminal Angioplasty Procedure and Recovery

• • • • The procedure will take place under local anesthesia (numbing of the incision site).
      • Whether you stay in the hospital will depend on several factors, including your condition and other tests and procedures being done.
      • Your physician will have specific orders about physical activity after you go home.
      • It’s very important to take the medication your physician prescribes to prevent more blockages.
      • You will need to return for follow-up to confirm that no new blockages have formed.
      • At some point in the future, the surgery may have to be adjusted or repeated.

      What is a stent?

      A stent is a mesh tube placed inside an artery to hold it open. If performed, stenting takes place just after the angioplasty balloon is used.

      • The catheter is withdrawn from the artery, and its balloon tip is loaded with the collapsed stent.
      • The catheter delivers the stent to the area of former blockage.
      • Your doctor inflates the balloon, causing the stent to expand.
      • When the balloon is collapsed, the stent remains in place.
      • The catheter and guide wire are removed.

      The mesh of the stent may be covered in synthetic fabric. It may also be coated in medicine that helps the artery heal with less scarring. This is called a drug-eluting stent.

      What is atherectomy?

      Atherectomy is the process of de-bulking — removing some of the plaque from a blockage. If performed, it takes place just before the angioplasty balloon is used.
      There are several different types of atherectomy procedures.

      Rotational atherectomy

      • A football-shaped bead (burr) coated in tiny diamond chips is placed on the catheter.
      • At the blockage site, the burr spins, grinding the plaque into microscopic particles.
      • The particles are disposed of by the body.

      Directional atherectomy

      • A hollow bead with a small opening is placed on a catheter balloon.
      • At the blockage site, the catheter balloon inflates, pushing the device’s opening toward the plaque.
      • The plaque is pressed into the opening
      • The opening has a sliding door. When the door closes, the plaque is cut off and safely stored inside the chamber.

      Laser atherectomy

      • A small laser is placed on the catheter.
      • The laser tunnels through the blockage, vaporizing the plaque in its path.

      What are other treatments for PAD (PVD)?

      Other treatments for peripheral artery disease include diet, exercise and medication to combat atherosclerosis, and open bypass surgery.

      Thromboembolectomy

      What is thrombectomy?

      Thrombectomy is a type of surgery to remove a blood clot from inside an artery or vein.

      Normally, blood flows freely through your blood vessels, arteries, and veins. Your arteries carry blood with oxygen and nutrients to your body. Yours veins carry waste products back to the heart. In some cases, the blood thickens and clumps to form a blood clot in one of these vessels. This can block the blood flow. When blood flow is blocked, nearby tissues can be damaged.

      During a surgical thrombectomy, a surgeon makes an incision into a blood vessel. The clot is removed, and the blood vessel is repaired. This restores blood flow. In some cases, a balloon or other device may be put in the blood vessel to help keep it open.

      Why might I need surgical thrombectomy?

      You might need surgical thrombectomy if you have a blood clot in an artery or vein. This surgery is often needed for a blood clot in an arm or leg. In some cases, it may also be needed for a blood clot in an organ or other part of the body.

      A blood clot can lead to many possible problems, such as:

      • Swelling, pain, numbness, or tingling in an arm or leg
      • A cold feeling in the area
      • Muscle pain in the area
      • Enlarged veins (postthrombotic syndrome)
      • Death of tissue
      • Loss of function of an organ
      • Blood clot moving to the lung that causes breathing trouble and risk of death (pulmonary embolism)

      Your doctor might advise surgical thrombectomy if you have a very large clot. Or, he or she may advise surgery if your blood clot is causing severe tissue injury. Surgery is not the only kind of treatment for a blood clot. Most people with blood clots are treated with medicines called blood thinners. These are given as an injection or through an IV. They can prevent a blood clot from getting larger.

      All treatments for blood clots have their own risks and benefits. Ask your doctor if surgical thrombectomy might be a good choice for you. You might find it helpful to talk to a doctor who specializes in blood vessel problems. This type of doctor is called a vascular specialist.

      What are the risks of surgical thrombectomy?

      All surgery has risks. The risks of surgical thrombectomy include:

      • Excess bleeding that can be severe enough to cause death
      • Infection
      • Damage to the blood vessel at the site of the blood clot
      • Reaction to anesthesia
      • Pulmonary embolism

      There is also a risk that your blood clot will form again. Your own risks may vary depending on your general health and how your blood clots. They may also vary depending on how long you’ve had the clot, and where it is in your body. Talk with your doctor about all your concerns and questions.

      How do I prepare for a surgical thrombectomy?

      Before the procedure, you will be asked to sign an Informed Consent form. This gives your permission to do the procedure. It also states that you fully understand the risks and benefits of the procedure and have had all of your questions answered. Before you sign, be sure all of your questions have been answered to your satisfaction.

      Talk with your doctor how to prepare for your surgery. Tell your doctor about all the medicines you take. This includes over-the-counter medicines such as aspirin, vitamins, and herbal supplements. You may need to stop taking some medicines ahead of time, such as blood thinners. If you smoke, you’ll need to stop before your surgery. Smoking can delay healing. Talk with your doctor if you need help to stop smoking.

      Before the procedure, make sure you tell the medical team if you:

      • Have any allergies
      • Have had any recent changes in your health, such as fever
      • Are pregnant or could be pregnant
      • Have ever had a problem with anesthesia

      You may need some tests before the procedure, such as:

      • Ultrasound, to measure blood flow in the leg and help diagnose the blood clot
      • Venogram (for a vein clot) or arteriogram (for an artery clot), to get an image of your vessels
      • Computed tomography (CT) scan, to get more information about the blood clot
      • Magnetic resonance imaging (MRI), if more information is needed
      • Blood tests, to check your overall health

      Do not eat or drink after midnight the night before your surgery.

      What happens during a surgical thrombectomy?

      Talk with your doctor about what to expect during the surgery. The details will vary depending on the type of your surgery. They will also vary depending on what part of the body is treated. A typical surgical thrombectomy may go like this:

      • An IV will be put in your arm or hand before the procedure starts. You’ll receive medicines through this IV. You may be given a blood thinner such as heparin. This is to help prevent new blood clots forming during the surgery.
      • You’ll also be given anesthesia through the IV line. This will prevent pain and make you sleep during the surgery. Or, you may be given sedation. This will make you relaxed and sleepy during surgery.
      • Hair in the area of your surgery may be removed. The area may be numbed with a local anesthesia.
      • The surgeon may use continuous X-ray images while the surgery is being done.
      • The doctor will make a cut in the area above your blood clot. He or she will open the blood vessel and take out the clot.
      • In some cases, a balloon attached to a thin tube (catheter) will be used in the blood vessel to remove any part of the clot that remains. A stent may be put in the blood vessel to help keep it open.
      • Your doctor will close and repair the blood vessel. This will then restore blood flow.
      • The incision on your skin will be closed and bandaged.

      What happens after a surgical thrombectomy?

      After the procedure, you will spend several hours in a recovery room. Your healthcare team will watch your vital signs, such as your heart rate and breathing. You may need to stay at the hospital for a day or more, depending on your condition. Your doctor will tell you more about what to expect.

      After the procedure, you may need to take medicine for a short time to help prevent blood clots. Your doctor will let you know about any other changes in your medicine. You can take pain medicine if you need it. Ask your doctor which to take.

      Your healthcare provider will likely advise you to get back on your feet soon after the treatment. You may need to wear compression stockings. This is to help prevent the clot from forming again. It can also help prevent a new one from forming.

      You should stop smoking. This will lower your risks of blood clots forming in the future. Talk with your doctor if you need help to quit smoking.

      Your doctor will keep track of your health after you go home. You’ll have follow-up appointments. Your doctor may check on your blood vessels with an imaging test called a venogram. Make sure to keep all of your follow-up appointments. This will help your doctor can keep track of your progress.

      Call your healthcare provider right away if you have any of the following:

      • Swelling or pain that gets worse
      • Fluid leaking from the incision
      • Fever
      • Bleeding anywhere on your body
      • Weakness, pain, or numbness in the surgery area

      Follow all of your doctor’s instructions. This includes any advice about medicines, exercise, and wound care.

      Arterial TPA

      Emergency treatment for stroke depends on whether you’re having an ischemic stroke or a stroke that involves bleeding into the brain (hemorrhagic).

      Ischemic stroke

      To treat an ischemic stroke, doctors must quickly restore blood flow to your brain. This may be done with:

      • Emergency IV medication. Therapy with drugs that can break up a clot has to be given within 4.5 hours from when symptoms first started if given intravenously. The sooner these drugs are given, the better. Quick treatment not only improves your chances of survival but also may reduce complications.An IV injection of recombinant tissue plasminogen activator (tPA) — also called alteplase (Activase) — is the gold standard treatment for ischemic stroke. An injection of tPA is usually given through a vein in the arm with the first three hours. Sometimes, tPA can be given up to 4.5 hours after stroke symptoms started.This drug restores blood flow by dissolving the blood clot causing your stroke. By quickly removing the cause of the stroke, it may help people recover more fully from a stroke. Your doctor will consider certain risks, such as potential bleeding in the brain, to determine if tPA is appropriate for you.
      • Emergency endovascular procedures. Doctors sometimes treat ischemic strokes directly inside the blocked blood vessel. Endovascular therapy has been shown to significantly improve outcomes and reduce long-term disability after ischemic stroke.

      These procedures must be performed as soon as possible:

      • Medications delivered directly to the brain. Doctors insert a long, thin tube (catheter) through an artery in your groin and thread it to your brain to deliver tPA directly where the stroke is happening. The time window for this treatment is somewhat longer than for injected tPA, but is still limited.
      • Removing the clot with a stent retriever. Doctors can use a device attached to a catheter to directly remove the clot from the blocked blood vessel in your brain. This procedure is particularly beneficial for people with large clots that can’t be completely dissolved with tPA. This procedure is often performed in combination with injected tPA.

      The time window when these procedures can be considered has been expanding due to newer imaging technology. Doctors may order perfusion imaging tests (done with CT or MRI) to help determine how likely it is that someone can benefit from endovascular therapy.
      Other procedures
      To decrease your risk of having another stroke or transient ischemic attack, your doctor may recommend a procedure to open up an artery that’s narrowed by plaque. Options vary depending on your situation, but include:

      • Carotid endarterectomy. Carotid arteries are the blood vessels that run along each side of your neck, supplying your brain (carotid arteries) with blood. This surgery removes the plaque blocking a carotid artery, and may reduce your risk of ischemic stroke. A carotid endarterectomy also involves risks, especially for people with heart disease or other medical conditions.
      • Angioplasty and stents. In an angioplasty, a surgeon threads a catheter to your carotid arteries through an artery in your groin. A balloon is then inflated to expand the narrowed artery. Then a stent can be inserted to support the opened artery.