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Peripheral Angioplasty in Hyderabad —
Leg Artery Blockage Treatment

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Dr Bhishma Chowdary cardiologist in Hyderabad
Dr Bhishma Chowdary cardiologist in Hyderabad

Peripheral Angioplasty in Hyderabad — Leg Artery Blockage Treatment

Peripheral artery disease (PAD) affects the blood vessels supplying the legs — causing pain on walking, non-healing wounds, and in severe cases, threatening limb loss. Peripheral angioplasty is a minimally invasive catheter-based procedure that opens blocked or narrowed leg arteries, restoring blood flow and relieving symptoms — without open bypass surgery. At AIG Hospitals, Gachibowli, Dr. Bhishma Chowdary performs peripheral angioplasty and stenting as part of a comprehensive vascular intervention programme.

At a Glance

Procedure type Peripheral vascular intervention — minimally invasive
Condition treated Peripheral artery disease (PAD) — blockages in leg arteries
Also treats Iliac, femoral, popliteal, and tibial artery blockages
Duration 1 to 3 hours depending on extent of disease
Anaesthesia Local anaesthesia + conscious sedation. Awake throughout.
Access Femoral artery in the groin (contralateral or ipsilateral approach)
Hospital stay 1 to 2 nights
Recovery Walking same day or next day. Return to normal activity within 1 to 2 weeks.
Performed by Dr. Bhishma Chowdary, DM Cardiology, AIG Hospitals Hyderabad
Appointment +91-9000352998

What is peripheral artery disease (PAD)?

Peripheral artery disease is the same atherosclerotic process that causes coronary artery disease — but affecting the arteries of the legs rather than the heart. Cholesterol plaques build up inside the arterial wall over years, progressively narrowing the vessel and reducing blood flow to the leg muscles, skin, and nerves.

PAD is extremely common and significantly underdiagnosed, particularly in India where diabetes prevalence is high. Diabetic patients are disproportionately affected — they develop PAD at younger ages, with more diffuse and severe disease, and more frequently at the level of the smaller tibial arteries supplying the foot. The consequences can be devastating if untreated — chronic ulcers, gangrene, and amputation.

PAD and the heart — why they go together

Peripheral artery disease is a strong marker of systemic atherosclerosis. Patients with PAD have a 3 to 4 times higher risk of heart attack and stroke than the general population — because the same disease process affecting the leg arteries is also silently advancing in the coronary and carotid arteries. Every patient with PAD requires a full cardiovascular risk assessment — including coronary artery evaluation.

Fontaine classification — staging PAD by symptom severity

Stage I Asymptomatic. Blockages present on imaging but the patient has no symptoms — often detected incidentally or by a low ankle-brachial index (ABI) on screening.
Stage IIa Intermittent claudication — calf, thigh, or buttock pain on walking that resolves with rest. Pain-free walking distance more than 200 metres. Symptoms manageable with supervised exercise and medications.
Stage IIb Intermittent claudication with pain-free walking distance less than 200 metres. Significantly limiting daily activities. Intervention strongly considered.
Stage III Rest pain — persistent pain in the foot and toes even at rest, typically worse at night and relieved by hanging the leg over the bed. Indicates severe ischaemia. Urgent intervention required.
Stage IV Tissue loss — non-healing ulcers, gangrene, or necrosis. Critical limb-threatening ischaemia (CLTI). Urgent revascularisation essential to prevent amputation.

Critical limb-threatening ischaemia (CLTI) — urgent action required

Stages III and IV (rest pain, ulcers, or gangrene) represent critical limb-threatening ischaemia. Without urgent revascularisation — within days, not weeks — the risk of major amputation is very high. If you or a family member has non-healing wounds on the foot or toes, blackening of toes, or severe foot pain at night, call +91-9000352998 immediately for urgent assessment.

Which arteries are treated with peripheral angioplasty?

The peripheral arterial tree supplying the legs has multiple levels — each associated with specific symptoms and treatment approaches:

Aorto-iliac segment (inflow disease) Blockages in the aorta or iliac arteries — the large vessels supplying blood from the abdomen to the legs. Causes buttock and thigh claudication, and in men, erectile dysfunction (Leriche syndrome). Iliac angioplasty and stenting are highly effective with excellent long-term patency.
Femoro-popliteal segment (outflow disease) The superficial femoral artery (SFA) and popliteal artery — the most commonly affected vessels in PAD. Causes calf claudication. SFA angioplasty with drug-coated balloons (DCB) or nitinol stents is the primary treatment. The SFA is a technically challenging vessel due to its length, movement, and susceptibility to stent fracture.
Tibial and peroneal arteries (below-the-knee) The three small arteries supplying the foot — anterior tibial, posterior tibial, and peroneal. Predominantly affected in diabetic PAD. Tibial angioplasty is technically demanding but essential for limb salvage in CLTI — restoring at least one direct line of flow to the foot to enable ulcer healing.
Popliteal aneurysm Aneurysmal dilatation of the popliteal artery — can cause acute leg ischaemia from thrombus or embolism. Treated with stent graft exclusion or surgical bypass depending on anatomy.

TASC classification — guiding treatment choice

The Trans-Atlantic Inter-Society Consensus (TASC) classification grades peripheral arterial lesions by complexity — helping guide whether endovascular (catheter-based) or surgical (bypass) treatment is more appropriate:

TASC A Short, focal lesions (single stenosis below 3 cm). Endovascular treatment — angioplasty — is the recommended first choice. Excellent outcomes.
TASC B Multiple lesions or single lesion 3–10 cm. Endovascular treatment preferred when technically feasible. Good results with drug-coated balloons and stenting.
TASC C Multiple bilateral lesions or single lesion 15–20 cm. Endovascular still attempted first at experienced centres. Surgical bypass considered for good-risk patients if endovascular fails.
TASC D Long diffuse disease, complete occlusions of major segments. Historically treated surgically. However, endovascular technology has advanced considerably — complex tibial and femoral recanalisation now achievable at specialist centres.

Modern endovascular techniques push TASC C and D boundaries

Advances in peripheral intervention — chronic total occlusion (CTO) crossing wires, subintimal angioplasty, re-entry devices, drug-coated balloons, and tibial retrograde access — have made many TASC C and D lesions treatable with catheter-based techniques at experienced vascular intervention centres. Dr. Bhishma Chowdary assesses each case individually using arterial duplex ultrasound and CT angiography before recommending treatment.

Diagnosis — how PAD is identified

Ankle-Brachial Index (ABI)

The ABI is the most important non-invasive test for PAD. It compares blood pressure measured at the ankle to blood pressure at the arm — in a healthy person these should be equal or the ankle should be slightly higher (ABI 0.9 to 1.3). A reduced ABI indicates arterial blockage in the leg:

ABI > 0.9 Normal.
ABI 0.7 – 0.9 Mild PAD. Often asymptomatic or mild claudication.
ABI 0.4 – 0.7 Moderate PAD. Significant claudication.
ABI < 0.4 Severe PAD. Rest pain or tissue loss. Urgent referral.
ABI > 1.3 Non-compressible vessels (heavily calcified arteries in diabetics). ABI unreliable — toe-brachial index (TBI) used instead.

Imaging investigations

  • Arterial duplex ultrasound — first-line imaging. Maps the entire lower limb arterial tree, identifying the level and severity of disease. Non-invasive and widely available.
  • CT angiography (CTA) — detailed anatomical mapping of the aorta, iliac, and lower limb arteries. Essential for treatment planning before peripheral angioplasty. Shows lesion length, calcification, and run-off vessels.
  • MR angiography (MRA) — alternative to CTA without radiation. Useful when iodinated contrast is contraindicated.
  • Diagnostic peripheral angiogram — invasive catheter-based angiography. Performed when CT/MR imaging is insufficient, or as the first step before planned simultaneous angioplasty.
  • Toe-brachial index (TBI) and toe pressure — used in diabetics with calcified incompressible arteries where ABI is unreliable. Toe pressure below 30 mmHg indicates severe ischaemia.

How is peripheral angioplasty performed? Step by step

Before the procedure

  • CT angiography reviewed to plan the access site, crossing strategy, and appropriate device selection (balloon sizing, stent type, drug-coated balloon vs bare balloon).
  • Dual antiplatelet therapy (aspirin + clopidogrel) started at least 5 to 7 days before elective peripheral intervention.
  • Renal function reviewed — contrast dye is used and patients with impaired kidney function require hydration preparation.
  • Fasting for 4 to 6 hours. IV access placed. Blood tests, ECG, and blood pressure checked.

During the procedure

  1. You lie on the procedure table. Local anaesthesia is injected at the access site — usually the groin (contralateral femoral artery for iliac/femoral disease, or ipsilateral antegrade approach for below-knee disease).
  2. A vascular sheath is placed in the femoral artery under ultrasound guidance. Heparin anticoagulation is administered.
  3. A diagnostic angiogram is performed first — confirming the lesion location, severity, and length, and assessing the run-off vessels (the arteries below the blockage that will receive blood flow once the blockage is opened).
  4. A guidewire is advanced to the blockage. Crossing the occlusion — particularly in long chronic total occlusions — is the most technically demanding step. Subintimal angioplasty technique may be used for long occlusions: deliberately entering the space between the artery wall layers and re-entering the true lumen beyond the blockage.
  5. The blockage is crossed and a balloon catheter is advanced to the lesion. Balloon angioplasty is performed — inflating the balloon for 60 to 120 seconds to compress the plaque and open the artery.
  6. For femoropopliteal disease: a drug-coated balloon (DCB) — coated with paclitaxel or sirolimus — is used to deliver antiproliferative medication directly into the arterial wall, reducing the chance of re-narrowing. This is the current standard of care for SFA disease, avoiding the need for a permanent stent in many cases.
  7. A stent is placed if the result after balloon angioplasty is suboptimal — significant residual narrowing, arterial dissection, or elastic recoil. Nitinol self-expanding stents are used for the SFA. Balloon-expandable stents for iliac and ostial lesions.
  8. For below-knee tibial angioplasty: very fine guidewires and balloons are used in the small 2–3 mm tibial arteries. The goal is to restore at least one direct line of flow to the foot — essential for ulcer healing in CLTI.
  9. Final angiography confirms improved blood flow through the treated segment and adequate run-off.
  10. The sheath is removed and the access site is closed with a manual compression or vascular closure device.

After the procedure

  • Bed rest for 2 to 4 hours with the leg kept straight if femoral access was used.
  • The foot and leg are assessed regularly — pulse checks, ankle pressure, and temperature to confirm restored blood flow.
  • Walking is encouraged the same evening or the following morning.
  • Dual antiplatelet therapy continued for at least 1 to 3 months after peripheral angioplasty, then aspirin lifelong.
  • For drug-coated balloon treatment: clopidogrel for 3 months minimum.
  • Discharge typically on day 2. Wound care instructions for any pre-existing ulcers.

Peripheral angioplasty vs bypass surgery

Angioplasty preferred when: Short or moderate lesions (TASC A and B), high surgical risk patients, elderly or frail patients, no suitable vein for bypass conduit, recurrent stenosis in a previous bypass graft, bilateral disease requiring treatment on both sides.
Bypass surgery preferred when: Very long diffuse disease not amenable to endovascular treatment (TASC D), failed prior angioplasty, good-risk patient with long life expectancy where durable surgical graft may outlast stents, combined aortic and iliac disease requiring aorto-bifemoral bypass.
Hybrid procedures In complex cases, a combination approach is used — for example, iliac stenting to improve inflow combined with a surgical femoro-popliteal bypass for outflow disease. Dr. Bhishma Chowdary works with the vascular surgery team at AIG Hospitals to plan hybrid cases jointly.

PAD and diabetic foot — the Hyderabad perspective

India has the second-largest diabetic population globally, and Telangana and Andhra Pradesh have particularly high diabetes prevalence. The combination of diabetes and PAD produces the most severe form of lower limb vascular disease — diffuse calcified tibial artery disease with poor wound healing, neuropathy, and high infection risk.

The diabetic foot with non-healing ulcers in the context of PAD is a limb-threatening and life-threatening emergency. The sequence of events — small wound → non-healing → infection → gangrene → amputation — is preventable in many cases if PAD is identified and treated early.

  • All diabetic patients should have an annual foot examination including pulse assessment and ABI measurement
  • Any non-healing wound in a diabetic patient that has not improved in 2 weeks warrants urgent vascular assessment
  • Below-knee tibial angioplasty — restoring blood flow to at least one tibial artery — is the key intervention for limb salvage in diabetic CLTI
  • A multidisciplinary team approach — vascular intervention, podiatry, wound care, diabetology, and orthopaedics — is the standard of care for diabetic foot disease with PAD

Do not delay seeking help for a diabetic foot wound

If you or a family member with diabetes has a wound on the foot or toes that is not healing, has changed colour, or has become infected — do not wait. Contact Dr. Bhishma Chowdary at AIG Hospitals on +91-9000352998 for urgent assessment. Early intervention can prevent amputation.

Frequently asked questions

What does leg pain on walking mean — is it always PAD?

Calf pain that comes on reliably after a certain distance of walking and resolves completely with a few minutes of rest — called intermittent claudication — is the hallmark symptom of peripheral artery disease in the femoropopliteal segment. However, not all leg pain on walking is PAD. Spinal stenosis (neurogenic claudication) causes similar symptoms — but typically also involves back pain and buttock discomfort, and does not resolve as quickly with rest. Muscle cramps, venous disease, and osteoarthritis can also cause leg pain. An ABI measurement and arterial duplex scan can distinguish PAD from other causes quickly and non-invasively.

Can peripheral angioplasty be done in both legs at the same time?

Yes, in selected cases. Bilateral iliac stenting or bilateral femoropopliteal angioplasty can be performed in the same session when disease is present on both sides. The decision depends on contrast dye load (which affects the kidneys), procedure duration, and the patient's overall condition. For very extensive bilateral disease, staging the procedures — treating the more symptomatic or more critically ischaemic side first — may be preferred to manage contrast dose and procedure complexity safely.

How long does the result of peripheral angioplasty last?

Durability depends on the vessel treated, lesion length, and whether a stent or drug-coated balloon was used. For iliac artery angioplasty and stenting, 5-year patency rates exceed 80%. For the superficial femoral artery, drug-coated balloon treatment achieves 12-month patency of approximately 75–80% — significantly better than plain balloon angioplasty. Below-knee tibial angioplasty has lower long-term patency than above-knee interventions, but the goal in CLTI is not permanent patency — it is sufficient blood flow for wound healing and limb salvage, which is achievable even with shorter-duration patency.

Will I need to take blood thinners after peripheral angioplasty?

Yes. After peripheral angioplasty, dual antiplatelet therapy — aspirin plus clopidogrel — is prescribed for 1 to 3 months depending on the type and complexity of the procedure. After a stent is placed, clopidogrel is continued for at least 3 months. Aspirin alone is continued lifelong. For patients with atrial fibrillation who are already on anticoagulants, the combination of anticoagulant and antiplatelet therapy is carefully planned to balance clotting and bleeding risk.

My toes are turning black — is it too late for angioplasty?

Not necessarily. Blackening of one or two toes (digital gangrene) with preserved viable tissue in the rest of the foot may still be salvageable with urgent peripheral angioplasty to restore blood flow. The extent of viable tissue, the presence of infection, and the anatomy of the remaining arteries all determine whether limb salvage is feasible. Even in advanced cases, restoring blood flow with angioplasty can allow a more limited local amputation of the affected toe rather than a major below- or above-knee amputation. Urgent assessment is critical — call +91-9000352998 immediately.

Is peripheral angioplasty safe for elderly patients?

Yes — elderly patients often benefit most from peripheral angioplasty precisely because they are at high surgical risk for open bypass surgery. Age alone is not a contraindication to peripheral angioplasty. The procedure is performed under local anaesthesia, requires no general anaesthesia, and allows walking the same day or next day. For very elderly or frail patients with CLTI, limb salvage through angioplasty — avoiding amputation and its associated mortality and loss of independence — represents a major quality-of-life gain. Dr. Bhishma Chowdary has experience managing complex tibial angioplasty for limb salvage in elderly diabetic patients.

Do I need to be referred by another doctor for peripheral angioplasty?

No referral is required to consult Dr. Bhishma Chowdary directly. Patients with leg pain on walking, non-healing foot wounds, cold or discoloured feet, or known peripheral artery disease can self-refer. However, Dr. Bhishma Chowdary also accepts direct referrals from diabetologists, general physicians, vascular surgeons, orthopaedic surgeons, and podiatrists for vascular assessment and peripheral intervention.

Why choose Dr. Bhishma Chowdary for peripheral angioplasty in Hyderabad?

  • Interventional cardiology training with specific expertise in peripheral vascular intervention — iliac, femoral, popliteal, and below-knee tibial angioplasty
  • Drug-coated balloon (DCB) technique for femoropopliteal disease — current standard of care for SFA angioplasty, reducing restenosis and repeat procedures
  • Complex peripheral CTO crossing — subintimal angioplasty and re-entry techniques for long chronic total occlusions
  • Below-knee tibial angioplasty for diabetic CLTI and limb salvage — technically demanding work requiring specific wire and balloon expertise
  • Ultrasound-guided vascular access — reducing access site complications particularly in patients with difficult anatomy
  • Full peripheral imaging at AIG Hospitals — arterial duplex ultrasound and CT angiography for pre-procedure planning and post-procedure surveillance
  • Multidisciplinary approach — works with vascular surgery for hybrid cases and diabetology/wound care for diabetic foot disease
  • Fluent consultations in English, Hindi, and Telugu

Book a peripheral angioplasty consultation in Hyderabad

If you have leg pain on walking, a non-healing foot wound, cold or discoloured feet, or have been told you have peripheral artery disease — contact Dr. Bhishma Chowdary at AIG Hospitals, Gachibowli, Hyderabad for specialist vascular assessment.

Call: +91-9000352998

Email: bhishmachowdary@gmail.com

Location: AIG Hospitals, Gachibowli, Hyderabad — 500032

Clinic hours: Monday to Saturday, 10:00 AM to 4:00 PM

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