During angioplasty, a physician makes a small incision into the skin above an artery in the arm or groin in order to access the artery. The physician then threads a balloon-tipped catheter from the incision site through the arterial system to the leg artery that is blocked or narrowed. Once the balloon is positioned under the plaque, the physician inflates it to break up and compress the plaque and widen the blood vessel, improving blood flow through the artery. In some cases, the physician may then insert a stent, a small metal-mesh tube, to prop open the artery following angioplasty.

When angioplasty is successful, it has excellent results. Approximately 60 to 70 percent of patients who have an angioplasty have patent vessels, or vessels that remain open to provide adequate blood flow to the legs, 2 years after the procedure. The initial failure rate for angioplasty in patients with leg artery disease is only about 10 percent. Failure may occur if the catheter is unable to move through the blockage or a weakened artery collapses after angioplasty and is impossible to keep open. 

Other techniques, including cryoplasty (a technique to freeze the plaque to prevent renarrowing) and atherectomy (a method of removing the plaque through a catheter) are also being used in treating leg arteries. Newer stent designs have demonstrated early improvements in keeping leg arteries open.

For more advanced forms of leg artery disease, procedures that are more invasive than angioplasty, usually a surgical bypass graft or endarterectomy, may be needed.