When an artery becomes blocked, blood can no longer reach the area it is supposed to supply. At the level of the legs, the responsible of the problem is PAD (obliterating arteritis of the lower limbs). Previously, to restore circulation in the affected limb, it was necessary to perform a bypass (bridge between two healthy areas). Or perform an endarterectomy: the vascular surgeon opens the artery, “scratches” the inside, then closes it. Today, it is often possible to avoid these heavy interventions, as explained by the experts gathered at the last congress of vascular surgery, which was held in Montpellier.
The balloon inflates to dilate the artery
The vascular surgeon inserts a “guide” into the artery, passes a balloon along the guide to the blocked area, and then inflates it. This allows the atheroma plaque to be crushed and embedded in the wall. After one to two minutes the balloon is removed. The first devices, of very small size (1 cm), were invented for cardiac surgeons in order to unclog the coronaries. ” The lesions of arteritis of the lower limbs can reach 10, 20 cm or more, explains Prof. Éric Steinmetz, vascular surgeon and deputy secretary general of the French Society of Vascular Surgery.. Longer balloons had to be developed (up to 22 cm for a few millimeters in diameter). In some cases, once the balloon has cleared the artery, there is a recurrence, that is, it closes. It is then necessary to place a stent, which is left in place in the artery to keep it open.
|
To better understand Why the artery is narrowed The person responsible for arteritis is atherosclerotic plaque. This deposit of cholesterol narrows the artery and obstructs the passage of blood. Result: the muscles, poorly oxygenated, become painful on exertion. A clot can form on this plaque and completely block the artery. |
The stent can diffuse a drug
The stent is a kind of little wire mesh spring that prevents the artery from closing. But the latter can consider it as a foreign body, make scar tissue and fill up. This is recurrence, occurring in 30 to 40% of cases. To avoid this, “active” stents have been developed which are impregnated with a slowly diffusing drug. Unlike the devices used for the heart, made of rigid steel, those of the lower limbs, and in particular the femoral artery, are made of Nitinol, which is very flexible. This shape memory alloy, formed from nickel and titanium, unfolds slowly at 37 ° C. ” In a few days, it gains volume and gradually pushes back the plaque. This type of stent is increasingly used in arteritis obliterans. », Specifies Professor Steinmetz.
The laser vaporizes the plate gently
It digs a tunnel in the artery to unblock it, moving forward slowly and detaching tiny fragments, naturally evacuated by the bloodstream. Advantage: unlike the balloon and the stent, which “encrust” the atheroma plaque in the wall, it removes it. The technique seems promising, both for unclogging an artery and for destroying scar tissue in the event of restenosis, but it remains to be evaluated. Each of these techniques has its applications. It is still necessary to know which is the right method for the right artery … The selection criteria are under discussion and are the subject of several studies. One thing is certain: vascular surgeons now have several effective tools at their disposal. And it is possible to restore the passage of blood through the arteries before the occurrence of complications.
For further
Focus on arteritis
