If conservative treatments, including medications, do not relieve your claudication, an invasive approach will be taken, as follows.
As first approach for treatment, PAD patients may routinely be referred to interventional physicians, which will try to restore the blood supply to the diseased artery by a minimally invasive procedure. The angioplasty ("repair of a blood vessel") is done by first accessing the artery at the groin area. Then, the physician passes the lesion with a very narrow metal wire called "guide wire", and once in place, a balloon catheter is advanced over the guide wire, all the way to the lesion in the artery. Once positioned inside the lesion, it is inflated to push and press the plaque into the vessel wall, to open the narrowed artery. The balloon is deflated and removed from the body, and sometimes is followed by an implantation of a metallic stent (expandable small metallic scaffold) inside the lesion that maintain it open longer-term.
Atherectomy is a minimally invasive procedure used to treat PAD in which a catheter, called an atherectomy catheter or atherectomy device, is inserted the same way as described above over the guide wire until reaching just before the lesion, where it is then activated to remove portions of plaque. The atherectomy technique cuts or vaporizes portions of the plaque from the wall of the artery. Once this step is done, a balloon is inserted over the guide wire as described above, but this time there is less material of plaque to be pressed against the artery wall, which usually helps to maintain the artery open for a longer time than just using the balloon without atherectomy. Sometimes the balloon action is followed by implantation of a metallic stent (expandable metallic scaffold) implantation to allow further support.
Once the PAD symptoms are present and cannot be treated with angioplasty (or angioplasty with atherectomy), the disease can progress and worsen to an unwanted progressing stage, called critical limb ischemia (CLI). In CLI the patient suffers significant pain in the leg (even is rest), and non-healing wounds, ulcers, extensive infections or even gangrene (tissue death) may develop in the affected leg or foot. Amputation - surgical removal of the affected leg or part of it (toe/s, foot, etc.) - may be necessary at this stage of the disease.
Usually if the angioplasty (or angioplasty and atherectomy) attempts fail to improve sufficient blood flow, a bypass surgery by a vascular surgeon is done. The bypass (made of a vein or a synthetic tube) connects the vessel area above the treatment-proofed lesion to a vessel area below it, to create an alternative path for blood flow around this treatment-proof lesion.