Texas Medical Center

New Procedure Unclogs Leg Arteries in Unconventional Way



By George Kovacik  |  Houston Methodist

When unclogging a drain, plumbers insert a device from the top and guide it down to push through the grease, hair, or whatever is causing the blockage.

Endovascular surgeons use the same technique when trying to open up the vessels of patients with peripheral artery disease, or PAD, a serious condition that develops when arteries in the legs become clogged. However, some patients’ vessels are so hardened that it’s impossible for surgeons to push through the blockage. A new technique called retrograde access now gives surgeons an additional path from below.

Hosam El-Sayed, M.D.

“There are three arteries that branch off into smaller arteries and supply blood to the legs and feet,” said Hosam El-Sayed, M.D., an endovascular surgeon with Houston Methodist DeBakey Heart & Vascular Center. “Over time, plaque can develop in the walls of these arteries and completely block the flow of blood to the lower extremities. Patients in this situation can develop severe conditions such as non-healing sores or gangrene, and could eventually face amputation.”

Retrograde access is a delicate procedure that allows surgeons to go through arteries in the foot and work their way upward. El-Sayed says this procedure is not for everyone with PAD, but instead is only for complex patients with heavily calcified arteries, where plaque buildup has become severely hardened. This happens in many people who have severe diabetes. In these patients, it is not possible to open up blocked arteries by the regular procedure coming from above.

“During this procedure, we access those blocked arteries both from the foot and from the top of the leg through the groin and meet in the middle,” El-Sayed said. “Once that occurs, we can open the vessels with a balloon, a stent, or we can shave the plaque that has built up over time and free blood flow to the legs and feet.”

El-Sayed says smoking puts people at highest risk for PAD, but diabetes, high blood pressure, high cholesterol, kidney failure and obesity are all contributing factors.

Some patients are told amputation is their only option, but El-Sayed says anyone with PAD who hears this should seek a second opinion.

“Retrograde access gives us another pathway to work through severely diseased arteries,” he said. “We have saved the limbs of many patients who three years ago were told by others that they would lose them.”