Contraindications to PTA of peripheral arteries are diffuse disease, long occlusions, and severe arterial calcification. Thrombosis at the site of dilation, distal embolization, intimal dissection with occlusion by a flap, and complications due to heparin therapy may require surgery. In aneurysms, endoluminal grafts are being investigated as an alternative to direct open surgery. Synthetic grafts are inserted via small catheters into the site of the aneurysm and expanded to cover the bulge in the vessel. These procedures are done in a radiology laboratory or operating room.
Mild sedation is used in most cases.
Once home, the patient should use aspirin or the antiplatelet drug ticlopidine. Such localization of the cause may allow a more focused angioplasty or surgical repair. Thromboendarterectomy is used for short localized lesions in the aortoiliac, common femoral, or deep femoral arteries. Synthetic polyester or polytetrafluoroethylene is the preferred material for an arterial prosthesis to bypass disease in the aortoiliac area. Either material can be used for femoropopliteal or tibial obstructions if saphenous vein is not available.