Specialists in the treatment of leg ischaemia

Endovascular treatment to restore blood flow to the leg and foot

Angioplasty of the superficial femoral artery and distal vessels is an endovascular procedure that restores blood flow to the leg and foot when the arteries are narrowed or blocked by atherosclerosis.

At the Diabetic Foot and Lower Limb Ischaemia Unit at the Publio Cordón Memorial Hospital, this treatment is used to restore arterial flow in patients with advanced peripheral arterial disease.

At certain stages of the disease, blood flow to the limb may be insufficient to maintain tissue viability. This condition is known as critical lower limb ischaemia, or, according to current terminology in international guidelines, chronic limb-threatening ischaemia (CLTI).

When this occurs, serious symptoms may develop, such as persistent pain at rest, non-healing wounds or necrosis of the toes or foot – conditions that can compromise the limb if circulation is not restored.

Arterial revascularisation procedures, such as angioplasty, enable these blockages to be treated from within the artery using catheters, dilation balloons and, where necessary, stents or other endovascular devices.

The aim of treatment is to restore blood flow to the leg and foot in order to preserve the limb and promote tissue healing.

Superficial femoral artery angioplasty is an endovascular procedure used to treat arterial narrowing and improve blood flow in the leg.

In which cases is this treatment recommended?

Angioplasty of the superficial femoral artery and distal vessels is considered for patients with advanced peripheral arterial disease who show signs of severe reduced blood flow to the limb.

In these situations, arterial blood flow to the foot is insufficient and the tissues begin to suffer from a lack of oxygen.

Clinical symptoms that may indicate this advanced stage of the disease include:

Persistent pain in the foot, even at rest
Ulcers or wounds that do not heal
Necrosis or gangrene in the toes or foot
Progressive deterioration of circulation in the limb.
Disabling intermittent claudication or ‘window-shop’ leg.

When these conditions arise, the aim of treatment is to restore arterial blood flow to the foot using revascularisation techniques, in order to preserve the limb and promote tissue healing.

The decision on treatment is always based on a comprehensive vascular assessment, which includes an evaluation of the arterial anatomy, the severity of the ischaemia and the patient’s general condition.

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Benefits of treatment and limb preservation

In patients with critical ischaemia or CLTI, the primary aim of angioplasty is to restore sufficient blood flow to the foot in order to preserve the limb and prevent the disease from progressing.

When circulation improves, significant clinical benefits can be observed:

Reduction in pain at rest
Improved ability to heal wounds or ulcers
Reduced risk of amputation
Improved limb function

In this context, treatment is aimed at preserving the limb and preventing amputation, which is the therapeutic priority in the advanced stages of vascular disease.

Signs that may indicate a serious lack of blood supply to the foot Certain clinical situations warrant priority vascular assessment: • Foot pain that occurs even at rest • Wounds or ulcers that do not improve with standard treatment • Cold, pale or discoloured toes • Wounds that progressively worsen • A history of peripheral arterial disease with rapid deterioration. In these cases, it is important to assess arterial circulation as soon as possible, as revascularisation may be necessary to save the limb.

How blood flow is assessed before an angioplasty

The decision to perform an angioplasty requires a specialist vascular assessment.

The assessment usually begins with a clinical examination and an arterial Doppler ultrasound, which allows blood flow to be analysed and any potential narrowings or blockages in the leg arteries to be identified.

Where necessary, additional imaging techniques are used to complete the assessment, such as:

CT angiography or MRI angiography, which visualise the arterial tree of the limb
Angiography, which shows the arteries with great precision and may form part of the therapeutic procedure itself.

These tests enable the location of arterial lesions to be identified and the most appropriate revascularisation strategy to be planned.

To confirm the diagnosis and assess treatment options

A diagnostic assessment involving a vascular examination and imaging tests enables the arterial circulation in the leg to be analysed and determines whether it can be treated using angioplasty or other revascularisation techniques.

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How is angioplasty of the superficial femoral artery and distal vessels performed?

Angioplasty is an endovascular procedure that treats arterial blockages from within the blood vessels, with the aim of restoring blood flow to the leg and foot.

At the Publio Cordón Memorial Hospital, these procedures are carried out in a hybrid operating theatre, a facility that combines advanced angiography technology with the full facilities of a vascular operating theatre. This enables endovascular procedures to be performed with a high level of technical control and patient safety.

In most cases, the procedure is carried out under local anaesthesia and light sedation, ensuring the patient remains comfortable throughout the procedure.

Access to the arterial circulation is gained via a small puncture in an artery, usually in the groin area. Through this access point, very fine guidewires and catheters are inserted and advanced through the arteries until they reach the site of the blockage.

Once the lesion has been located using angiography, an angioplasty balloon is inserted and inflated for a few seconds to widen the artery and restore blood flow.

In certain cases, a vascular stent may be implanted; this is a small metal mesh that acts as an internal support to keep the artery open and improve blood flow.

When arterial disease affects segments below the knee, treatment may also involve distal or infrapopliteal arteries — such as the tibial arteries or the peroneal artery — using devices specifically designed for smaller-calibre vessels.

The procedure usually takes between 45 minutes and two hours, depending on the extent of the arterial disease and the complexity of the lesions being treated.

Benefits of endovascular treatment When appropriately indicated, endovascular treatment can offer: • A minimally invasive procedure • Less invasive than open surgery • The possibility of treating the femoral, popliteal and distal arteries • Generally a quicker recovery. The revascularisation strategy should be tailored to each patient’s arterial anatomy and individual characteristics.

Recovery and follow-up

Following the procedure, a period of observation is required to monitor the puncture site and the circulation in the limb.

In many cases, the hospital stay is brief, although closer monitoring may be necessary for patients with advanced critical ischaemia or complex wounds.

Follow-up care is an essential part of the treatment. As well as checking the patency of the treated arteries, measures are taken to manage cardiovascular risk factors, such as smoking, diabetes or high cholesterol.

Regular vascular follow-up enables the early detection of any restenosis or new blockages and helps maintain adequate blood flow in the treated limb.

Specialist assessment at the Diabetic Foot and Lower Limb Ischaemia Unit

Angioplasty of the superficial femoral artery and distal vessels is indicated following an individualised assessment of the circulation in the limb.

At the Diabetic Foot and Lower Limb Ischaemia Unit at the Publio Cordón Memorial Hospital, the vascular team analyses the arterial anatomy, the severity of the ischaemia and the patient’s general condition to determine the most appropriate revascularisation strategy.

Depending on the individual case, treatment may include endovascular procedures such as angioplasty, bypass surgery or a combination of both techniques.

The aim is to restore sufficient blood flow to the foot to preserve the limb and promote tissue recovery.

Specialists in the treatment of leg ischaemia using femoral and distal angioplasty