Leaders in Limb Salvage and PAD Treatment

Western Surgical Group’s vascular surgeons are Northern Nevada’s leading experts in treating peripheral artery disease (PAD) and chronic limb-threatening ischemia (CLTI). We offer both minimally invasive endovascular procedures and open surgical bypass, having established limb salvage programs in the community and at local hospitals.

Starting Fall 2025: Outpatient minimally invasive treatment at Galena Surgical Center — helping patients avoid the hospital, expedite care, and lower costs.

Conditions We Treat:

  • Peripheral Artery Disease (PAD)
  • Chronic Limb-Threatening Ischemia (CLTI)
  • Deep Vein Thrombosis (DVT)
  • Varicose Veins
  • Vascular Trauma
  • Non-healing wounds due to poor circulation

What Is Peripheral Vascular Disease?

Peripheral vascular disease (PVD) refers to conditions affecting the blood vessels outside the heart and brain — most commonly the arteries and veins in the legs and arms.

Peripheral Artery Disease (PAD)

PAD occurs when arteries in the legs become narrowed or blocked due to plaque buildup (atherosclerosis), reducing blood flow to the muscles and tissues.

Symptoms of PAD:

  • Leg pain when walking (claudication) that improves with rest
  • Numbness or weakness in the legs
  • Coldness in the lower leg or foot
  • Slow-healing sores on feet or legs
  • Change in leg color
  • Hair loss or slow hair growth on legs
  • Shiny skin on legs
  • Weak or absent pulses in legs or feet

Risk Factors:

  • Smoking (most significant)
  • Diabetes
  • High blood pressure
  • High cholesterol
  • Age over 50
  • Obesity
  • Family history
  • Sedentary lifestyle

Chronic Limb-Threatening Ischemia (CLTI)

CLTI is the most severe form of PAD, where blood flow is so reduced that patients develop rest pain, non-healing wounds, or tissue death (gangrene). Without treatment, CLTI can lead to amputation.

Warning Signs of CLTI:

  • Pain in feet or toes at rest, especially at night
  • Wounds or ulcers that don’t heal
  • Gangrene (tissue death)
  • Blackened or discolored toes

Other Peripheral Vascular Conditions

Deep Vein Thrombosis (DVT) — blood clots in the deep veins of the legs that can cause swelling, pain, and potentially life-threatening complications if the clot travels to the lungs.

Varicose Veins — enlarged, twisted veins that can cause aching, swelling, and skin changes.

Vascular Trauma — injuries to blood vessels from accidents, trauma, or complications from medical procedures.

Our Peripheral Vascular Disease Procedures

Minimally Invasive Endovascular Procedures

1. Angioplasty and Stenting

Opening Blocked Arteries from the Inside

How It Works:

A catheter with a small balloon is guided through the blood vessels to the blocked or narrowed artery. The balloon is inflated to compress the plaque and widen the artery. A stent (small mesh tube) is often placed to keep the artery open.

Advantages:

  • Minimally invasive (small puncture in groin or arm)
  • Performed under local anesthesia with sedation
  • Same-day or overnight stay
  • Quick recovery
  • Can treat multiple blockages in one session

Best For:

  • Focal arterial narrowings or blockages
  • Patients with claudication
  • Early to moderate PAD
  • Combined with other procedures for complex disease

2. Atherectomy

Removing Plaque to Restore Blood Flow

How It Works:

Atherectomy uses specialized catheters with cutting, grinding, or laser devices to actually remove plaque from inside the artery rather than just compressing it. This can be particularly useful for heavily calcified lesions or in smaller arteries.

Types:

  • Directional atherectomy (cuts and removes plaque)
  • Rotational atherectomy (grinds plaque into tiny particles)
  • Laser atherectomy (vaporizes plaque)
  • Orbital atherectomy (sands away plaque)

Best For:

  • Heavily calcified blockages
  • Long segments of disease
  • Small arteries below the knee
  • Preparation before stenting

3. Thrombectomy

Emergency Removal of Blood Clots

How It Works:

Thrombectomy removes blood clots from arteries or veins to restore circulation. This can be done mechanically (using a catheter device to extract the clot) or with thrombolytic therapy (clot-dissolving medications delivered directly to the clot).

When It’s Used:

  • Acute limb ischemia (sudden loss of blood flow)
  • Deep vein thrombosis (DVT)
  • Graft or stent thrombosis
  • Emergency situations

Best For:

  • Acute arterial blockages
  • Threatened limb viability
  • Recent blood clots
  • Patients who can’t tolerate prolonged clot-dissolving therapy

Open Surgical Procedures

Surgical Bypass

Creating a New Route for Blood Flow

When endovascular options aren’t suitable or have failed, surgical bypass creates a new pathway around the blocked artery using either the patient’s own vein (typically from the leg) or a synthetic graft.

How It Works:

The surgeon makes incisions to access the blocked artery above and below the blockage. A graft (vein or synthetic tube) is sewn to the artery above and below the blockage, creating a bypass route for blood to flow around the obstruction.

Common Bypass Types:

  • Femoral-popliteal bypass (thigh to knee)
  • Femoral-tibial bypass (thigh to lower leg)
  • Aortobifemoral bypass (abdomen to both legs)

When It’s Needed:

  • Long segments of arterial blockage
  • Multiple blockages not suitable for endovascular treatment
  • Failed previous endovascular procedures
  • CLTI with tissue loss requiring maximal blood flow
  • Younger patients needing durable long-term results

Recovery:

  • Hospital stay 3-7 days
  • Several weeks for incisions to heal
  • Gradual return to activities over 4-8 weeks
  • Long-term graft surveillance with ultrasound

Treatment for Varicose Veins

While we focus primarily on arterial disease and limb salvage, our vascular surgeons can evaluate and treat symptomatic varicose veins when they cause pain, swelling, skin changes, or ulcers. Treatment options may include:

  • Endovenous laser ablation
  • Radiofrequency ablation
  • Sclerotherapy
  • Microphlebectomy

Our Comprehensive Approach to Limb Salvage

Western Surgical Group takes a multidisciplinary approach to saving limbs threatened by PAD and CLTI:

1. Aggressive Revascularization
Using the full range of endovascular and open techniques to restore blood flow

2. Wound Care Coordination
Working closely with wound care specialists for optimal healing

3. Infection Management
Coordinating with infectious disease specialists when needed

4. Diabetic Foot Care
Partnering with podiatrists and endocrinologists for comprehensive diabetic limb care

5. Risk Factor Modification
Addressing smoking, diabetes, blood pressure, and cholesterol

6. Long-Term Surveillance
Regular follow-up to maintain results and detect problems early

Why Choose Western Surgical Group for PAD Treatment?

  • Region’s leading limb salvage experts — established programs throughout the community
  • Full range of treatment options — from minimally invasive to complex bypass surgery
  • Outpatient surgical center (Fall 2025) — avoid hospital stays
  • Comprehensive wound care coordination
  • Board-certified vascular surgeons with extensive PAD experience
  • Personalized treatment plans based on disease severity and patient goals
  • Proven track record in limb preservation

When Is Treatment Recommended?

Conservative Management:

Mild PAD may be managed with:

  • Exercise therapy (supervised walking programs)
  • Medications (antiplatelet drugs, cholesterol-lowering, blood pressure control)
  • Smoking cessation
  • Risk factor modification

Intervention Indicated:

  • Lifestyle-limiting claudication despite medical therapy
  • Rest pain
  • Non-healing wounds
  • Tissue loss or gangrene
  • Acute limb ischemia (emergency)

Your vascular surgeon will create a treatment plan based on your symptoms, disease severity, overall health, and goals.

Recovery and Long-Term Care

After Endovascular Procedures:

  • Same-day or overnight hospital stay
  • Resume walking within a day
  • Return to normal activities within 1-2 weeks
  • Groin or arm puncture site care

After Bypass Surgery:

  • Hospital stay 3-7 days
  • Walking encouraged soon after surgery
  • Incision care and activity restrictions
  • Full recovery 4-8 weeks

Long-Term Management:

  • Regular follow-up with vascular imaging
  • Continued medical management
  • Antiplatelet medications
  • Risk factor control (smoking cessation, diabetes management, etc.)
  • Exercise program
  • Foot care (especially for diabetics)

Benefits of Peripheral Vascular Disease Treatment

  • Relief from leg pain and improved walking ability
  • Healing of wounds and ulcers
  • Prevention of limb loss
  • Improved quality of life
  • Reduced cardiovascular risk through risk factor management
  • Options for both minimally invasive and traditional surgical approaches

Risks and Considerations

Treatment risks vary based on the procedure but may include:

  • Bleeding or hematoma
  • Infection
  • Arterial injury or perforation
  • Graft failure or thrombosis
  • Kidney injury from contrast dye (endovascular procedures)
  • Amputation (in severe cases despite treatment)
  • Cardiovascular complications

Your surgeon will discuss specific risks based on your health status and chosen treatment.

Divisions Involved in Your Care

Nothing Found

Diagnoses We Treat

Frequently Asked Questions

PAD is a general term for peripheral artery disease, which ranges from mild blockages causing leg pain with walking to severe blockages. CLTI (chronic limb-threatening ischemia) is the most severe form of PAD where blood flow is so reduced that patients have rest pain, wounds that won't heal, or gangrene. CLTI is a limb-threatening emergency requiring prompt treatment.

While the underlying atherosclerosis cannot be completely reversed, treatments can significantly improve blood flow, relieve symptoms, and prevent progression. Aggressive risk factor modification (especially smoking cessation) combined with appropriate procedures can lead to substantial improvement.

Stent patency (staying open) varies depending on location, disease severity, and patient factors. Stents in larger arteries like the femoral artery generally have better long-term results than those in smaller below-knee arteries. Many patients maintain good results for years, though some may need additional procedures over time.

Neither is universally "better" — each has advantages in different situations. Bypass surgery generally provides more durable results and is preferred for long segments of blockage, young patients, or when maximal blood flow is needed (CLTI). Stenting offers faster recovery and is excellent for focal blockages. Your surgeon will recommend the best approach for your specific situation.

Untreated PAD tends to progress over time. Lifestyle-limiting claudication worsens, potentially progressing to rest pain and tissue loss. CLTI without treatment frequently leads to amputation. Additionally, PAD is a marker for cardiovascular disease, increasing risk of heart attack and stroke. Early treatment and risk factor modification can prevent these outcomes.

Many patients with mild to moderate PAD can be managed with supervised exercise therapy, medications, and risk factor modification. However, if symptoms significantly limit your lifestyle despite these measures, or if you develop CLTI, intervention is typically necessary to improve blood flow.

Most patients experience significant improvement in walking ability after successful treatment. The degree of improvement depends on the severity of disease, completeness of revascularization, presence of other conditions, and participation in rehabilitation/exercise programs.

Smoking is the single most important modifiable risk factor for PAD. Continued smoking dramatically increases the risk of:

  • Progression to CLTI
  • Graft or stent failure
  • Amputation
  • Heart attack and stroke

Smoking cessation is essential for optimal treatment outcomes.

Starting Fall 2025, we'll offer minimally invasive peripheral vascular procedures at Galena Surgical Center. This allows patients to have procedures in a comfortable outpatient setting, avoid hospital admission, receive more personalized care, and often at lower cost. Not all procedures can be done in this setting, but many routine interventions will be available.

Many patients notice improvement immediately or within days after successful revascularization. Relief of rest pain and claudication can be dramatic. Wound healing takes longer — weeks to months depending on size and severity. Your care team will monitor your progress closely.