Blocked arteries & leg pain

Dr Marios Agathangelou performs angioplasty and stenting for narrowed arteries in Nicosia and Limassol, Cyprus — covered by GESY, €0 for GESY beneficiaries. Angioplasty treats narrowed or blocked arteries — most often in the legs (peripheral arterial disease) — through a 1–2 mm incision. A balloon gently expands the narrowing from within; where needed, a stent holds the vessel open.

Flow is restored through the treated segment. Walking distance and rest pain typically improve, and wounds receive the circulation they need to heal — without open vascular surgery.

Blood flow restored 1–2 mm incision Limb-saving potential Short stay

The procedure is fully covered by GESY. It is done as an inpatient admission, and that admission includes the treatment — you pay nothing for the procedure.

Separately, the outpatient visit — the initial assessment, where it is decided whether the treatment suits you — may carry a small co-payment, usually €0–10, as any specialist visit within GESY does.

The co-payment is per activity, and it stops once your total co-payments for the year reach €150 — past that you pay nothing. Some categories of beneficiary have different limits.

Both need a valid referral, from your personal doctor or from a specialist.

Outside GESY, or with private insurance? We provide the documentation your insurer asks for, and a clear cost estimate at your consultation, before you decide anything.

Leg pain on walking that eases with rest (intermittent claudication) and pain that is present at rest, or a wound that will not heal, are not the same thing. The second threatens the limb and needs prompt treatment — if you have rest pain or a wound that is not healing, do not wait. The first, in most cases, is not treated with a procedure first.

A leg that hurts when you walk is rarely a leg that is lost. It is worth hearing that first, because the fear of amputation is usually out of proportion to what actually happens: in most people with claudication the walking distance holds steady, or changes slowly, over years.

How far does it usually go? In the literature summarising the natural course of intermittent claudication, about one person in four sees the symptoms worsen over the years, while between one and three in a hundred come in the end to a major amputation.

Pain that wakes you at night, though, or a sore on a toe or a heel that will not close, does not belong to the same story. There the blood supply is not enough even at rest, and time counts differently.

In a Dutch study of 150 people with a threatened limb whose arteries could not be reopened, five years on about one in three had lost the leg and about one in three had died. Most of the amputations happened inside the first year.

The hard part about that second situation is that it does not always give warning. Where diabetes is also present, neuropathy blunts the pain, and the first sign can be a wound that appeared without being felt. That is why a diabetic foot is examined regularly rather than left to complain.

Waiting does not cost the same in every artery. A narrowing a few centimetres long is easier to deal with than a blockage that has taken the whole length of the vessel, and the fine arteries below the knee carry their own difficulty. That is not a reason to decide today — it is a reason to have the imaging done, so that you know where you stand.

Two different timescales, then, and only an examination shows which one you are on. If it hurts only when you walk, you have time. If it hurts lying down, or a sore will not close, it is not something that waits.

And if you do not know at this moment which of the two you are in — that is exactly what you are coming to find out. The first visit commits you to nothing.

For intermittent claudication, European guidance places a supervised exercise programme as first-line treatment — before angioplasty. This is not consolation advice: in pooled analyses of trials, supervised exercise substantially increases how far you can walk before the pain starts.

Alongside it, stopping smoking and controlling blood pressure, blood sugar and cholesterol matter — because narrowed arteries in the legs are a marker for the heart and brain, not just a local problem. Angioplasty has its place when those are not enough, or when the limb is threatened.

The usual complications appear at the puncture site in the groin: a bruise that spreads over the first few days, tenderness when you sit, sometimes a small hardening under the skin. All three settle on their own.

When the bleeding is more extensive it needs treating. That case, though, is uncommon. In an American national registry of roughly 95,000 planned procedures on the arteries of the legs, it happened to 2 in every 100.

Inside the artery itself two things can go wrong, each in fewer than 1 in 100 of that same registry: the wall injured by the wire or the balloon, or a fragment of plaque carried downstream to block a smaller vessel. Both are visible on the imaging there and then, and both are dealt with in the same sitting.

Two things change the picture: the kidneys and the heart. The procedure needs contrast, which can be a load on kidneys that are already weakened. In that same registry about 1 in 100 had a cardiac event related to the procedure. So kidney function and cardiac history are checked beforehand, and sometimes they change the plan or the order of the steps.

Sometimes the wire does not cross. An old, calcified blockage resists every antegrade attempt, and then the retrograde approach is tried, through a vessel lower down. In two published series of exactly such cases — the ones where the usual route had already failed — the artery was opened in the end in about 9 out of 10. When it does not open, the procedure stops there; the picture we have shows what the next step is, and a surgical bypass stays on the table.

The difference that counts for more than any complication is that the artery can narrow again and need a second procedure. In an American series of 448 people treated for claudication, about 1 in 8 reached a threatened limb over roughly four years of follow-up.

It is worth knowing what angioplasty does not solve, too. Not every pain that stops you walking is arterial — spinal canal narrowing and hip arthritis give a similar picture. Which is why the assessment beforehand is not confined to the vessels.

Afterwards the puncture site is pressed until it is secure and watched for a few hours; most people walk the same day. The follow-up plan is set individually, and within it the walking and the medication are not an add-on to the procedure: they are what keeps its result open.

Think over the numbers I have set out for you. No question is an embarrassment to ask.

Clinical statements on this page follow the European Society for Vascular Surgery guidelines on peripheral arterial disease and intermittent claudication, and published trials of supervised exercise. The figures in the risk and untreated sections come from a national vascular registry and from published cohort studies, each recorded in the site’s claims register. They describe these treatments in general; they are not advice about your case.

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