Stents vs. Surgery for Clogged Arteries

Stents may be a better treatment for PAD than femoral popliteal bypass surgery

(RxWiki News) People with peripheral arterial disease (PAD) in the legs may not need to go to the extremes of surgery to treat their condition.

PAD is a condition in which the blood vessels, usually in the legs, become narrow, which limits blood flow to the affected extremity. The narrowness of the blood vessels can help doctors determine whether or not surgery is a necessary treatment.

A common surgery used to treat PAD in the legs is known as femoral-popliteal bypass. The surgery involves taking a piece of a vein, or vein graft, found within the leg and bypassing the clogged artery with the grafted vein. With this procedure, blood can flow past the clogged part of the blood vessel.

A recent study found that stent patients were less likely to need follow-up surgery within two years versus patients who had a vessel bypass as their first procedure instead of a stent.

Stents are small mesh tubes that support the inner walls of narrowed blood vessels, thus improving blood flow.

"Ask your doctor about treatment options for clogged arteries."

From this study, Mahmoud B. Malas, MD, MHS, associate professor of surgery at the Johns Hopkins University School of Medicine, director of endovascular surgery and director of The Vascular and Endovascular Clinical Research Center at Johns Hopkins Bayview Medical Center, and colleagues aimed to determine when a stent is a better treatment option for a patient than bypass surgery.

The research was conducted on a small sample of patients with PAD from September 2005 to September 2010. During this time, the study compared the long-term effectiveness of stents on one group of patients and the long-term effectiveness of surgery on the other group of patients.

A total of 104 patients with PAD in the legs were studied. On average, the patients were 68 years of age.

The rate of intervention to restore blood circulation in two years time in the stent group was lower than in the group that underwent surgery. The rate of re-intervention was 54 percent for the bypass group, whereas the rate of re-intervention for those who received stents was only 31 percent.

The study also revealed that women were two times more likely to need a second operation than men.

The severity of each group's PAD was not the same, however. Before treatment, approximately 77 percent of the patients who received stents had considerably smaller blockages within their arteries, whereas about 73 percent of those who underwent surgery had larger blockages.

Due to this difference, the researchers could not determine whether or not stents were a better treatment option for PAD that is more severe.

According to Dr. Malas, it is difficult to determine the best course of action for medium-sized blockages, since the patients with longer blockages in this study were more likely to have had a stent in the past that failed.

It is also important to stress that stents do not cure clogged arteries. PAD tends to be the reason why plaque accumulates in the arteries. The stents merely improve circulation within the legs but do not cure the underlying disease.

Patients are encouraged to learn about all their treatment options for PAD. Ask your doctor about treatments for clogged arteries and what steps you can take to help reduce the amount of plaque build-up.

This study was published online July 24 in the Journal of Vascular Surgery. The study was funded by John Hopkin's Bayview Medical Center. The authors disclosed no conflicts of interest.

Review Date: 
August 13, 2013