Surgical treatments

What surgical treatments are available?

Surgical treatments are offered to people whose condition is not improved by medication and/or walking therapy. These treatments are also recommended if the blood supply to the legs decreases significantly. This can affect the patient’s quality of life and even result in amputation.

There are two types of invasive treatments: percutaneous angioplasty and surgery. In both cases, the goal is to increase blood flow to the affected leg(s). Surgery is considered to be the treatment of last resort.

Percutaneous angioplasty

The aim of this treatment is to remove the blockage in a narrowed artery in order to permit better blood circulation.


A catheter is inserted into the artery in the groin (but sometimes also in the arm).

By injecting a dye, the physician can follow the path of the catheter in the arteries with the help of X-rays (this is called fluoroscopy). The catheter is guided to the point where there is a narrowing of the artery. A tiny balloon is then advanced to the narrowed or blocked artery and gently inflated until the artery is sufficiently widened.

Other possibilities during treatment:

The physician may also insert a wire mesh tube called a “stent” inside the artery to decrease the chance of the artery narrowing again.

Percutaneous angioplasty is performed at the hospital and takes one to two hours. An overnight hospital stay is not necessary.

Potential complications:

Complications may occur, but they are rare. The healthcare team will monitor you for bleeding at the site where the catheter was inserted or for an allergic reaction to the dye. You can discuss this with your doctor.

Surgical treatment is mainly aimed at restoring blood flow. Surgery is performed in an operating room.

Several tests and appointments are necessary prior to surgery (see the sections on physical examination and tests).


Endarterectomy is a technique that involves unclogging the arteries with open surgery: the skin is cut open with a scalpel.

The surgeon then removes the plaque formed by atherosclerosis that is responsible for clogging the artery in the leg (called the common femoral artery) which is located in the groin (upper thigh).

The surgeon makes a skin incision in the fold of the groin. The plaque is then removed from the artery and the artery is closed with stitches.

Aortic surgery

Arterial “blockages” can also occur in the abdominal area in the aorta, which is the largest artery in the human body, or in two of its main branches, the iliac arteries.

In aortic surgery, the diseased aorta is replaced with a synthetic prosthesis that improves blood flow to the legs. The procedure can take several hours and may involve groin incisions, blood transfusions (in some cases), hospitalization and post-operative follow-up in a specialized care unit.

Hospitalization can last several days and recovery may take two months or more.

Don’t be surprised if your surgeon insists that you quit smoking prior to having this surgery, as pulmonary or cardiac complications are frequent and dangerous.

Bypass surgery

When blocked arteries are located in the thigh or calf, a bypass in the leg may be considered. Using the {saphenous vein}, the surgeon constructs a “bridge” over the obstructions in the arteries, rerouting the blood so that it can flow normally back to the affected organs and tissues.

Déroulement : la veine saphène est prélevée pour remplacer la longueur de l’artère qui est bloquée dans la jambe. Procedure: The saphenous vein is removed to replace the section of the artery in the leg that is blocked. The length of the bypass can extend from the groin to above the knee, or sometimes to below the knee or even into the foot.

A synthetic graft may be used if the patient’s saphenous vein has already been used or if it is not long enough or not of good quality.


When blood is no longer able to circulate, necrosis, or the death of cells and living tissue, is inevitable. This can lead to gangrene. The dead tissue must then be removed (debridement) to allow the wound to heal. In the most severe cases, amputation of one or more toes, part or all of the foot and sometimes even the leg is necessary. The challenge is to limit the loss of living tissue by revascularizing the leg (allowing blood to return to the limb) and removing all the devitalized tissue.

If major amputation is unavoidable, a specialized team including physiotherapists and occupational therapists will assist with the patient’s rehabilitation.