Non surgical peripheral artery disease or peripheral arterial disease (PAD) treatments
Treatment aims to avoid surgery which can be vascular surgery or amputation. In vascular surgery diseased portions of arteries are bypassed using synthetic or vein grafts. In amputation irreversibly damaged parts of the limb are cut off to prevent life threatening infection.
There are many non-surgical treatments of peripheral artery disease (PAD) that exist to avoid the risks and trauma associated with surgery. They can be used together before surgery either to cure PAD or to delay surgery - especially amputation - for a significant amount of time.
What is peripheral arterial disease (PAD)?
Peripheral artery disease (PAD) is a condition in which narrowed peripheral arteries reduce blood flow to your limbs. For diseases like peripheral arterial disease (PAD) and diabetic foot ulcers non surgical treatments can prevent amputation of the limb.
Peripheral arterial disease (PAD) is most commonly caused by atherosclerosis , a condition where plaque - fatty deposits on the artery walls - slowly builds up in the body's arteries. The condition mainly affects legs and arms but can also occur neck, kidneys, or heart. Atherosclerosis is also associated with coronary artery diease and heart attack, and carotid artery disease and stroke. This blood vessel disease caused by fatty plaque buildup reduces blood flow and therefore causes peripheral artery disease (PAD) symptoms including leg pain and cramps.
Treatments can focus on either:
- treating atherosclerosis - plaque buildup - that causes narrowed and blocked arteries with medicines and other methods, and/or
- using advanced non surgical interventions inside the arteries to clean up the material clogging the artery and to hold it open using mesh-like cylinders (stents)
What are the symptoms of PAD?
Symptoms are also warning signs to seek help. They include:
- leg pain (especially during walking), leg cramping and tiredness, and/or
- numbness or pain in the toes; legs may feel heavy.
When these symptoms appear, they tend to worsen with physical activity and improve with rest. They also often get worse at night and go away after a few minutes of warming your legs. Symptoms can be related to clogged arteries even if you don't have any other signs or symptoms of heart disease such as chest pain or shortness of breath. You might not link your leg discomfort to coronary artery disease because it is typically more severe in the upper body than in the lower body where circulation is poor.
What are severe PAD symptoms?
Severe symptoms include leg or muscle pain at rest called claudication. Claudication is usually relieved promptly with rest. PAD symptoms may be described as intermittent claudication (most common) or rest pain.
The most feared consequence of severe PAD is tissue death and gangrene, a result of a process called critical limb ischemia. You can experience wounds that won't heal, ulcers on your feet or legs, and your toes might become cold as well as numb – a telltale sign of critical limb ischemia. No or poor blood flow causes tissue death, and you are at increased risk of requiring and amputation to prevent serious infection.
Even though it may seem like this happens quickly, damage from PAD usually progresses slowly over time. That's why it's important for you to seek an early diagnosis.
What are the risk factors for peripheral artery disease?
The following are some of the main risk factors associated with PAD:
- Diabetes
- High blood cholesterol and/or triglycerides
- Smoking
- Obesity
- Family history
- Lack of exercise
Early on there may be mild or no symptoms.
What non surgical treatments are available for peripheral arterial disease (PAD)?
Non surgical peripheral arterial treatments include:
- lifestyle medications,
- medicines
- endovascular techniques: specialized interventions performed inside the diseased vessel using a "pinhole" technique
What surgical treatments are available peripheral artery disease (PAD)?
The main surgical techniques are:
- arterial vascular bypass
- endarterectomies
- amputation
What is an arterial bypass?
An arterial bypass is surgery to reroute blood flow around a blockage in an artery. Using a new vessel of graft blood can be rerouted around the blocked, disease part of the artery. This is done with synthetic material or by using veins from another part of your body. A vascular surgeon who specializes in medical procedures to treat vascular disease and improve blood flow may perform this surgery.
What is an endarterectomy?
An endarterectomy is a procedure that removes plaque from inside an artery. Endarterectomies are often done to treat people with PAD who have severe symptoms that have not been controlled by other treatments. It can be done as open surgery by a vascular surgeon.
Why are amputations performed?
Amputation may be needed to treat people with PAD if they are not helped by other treatments and the disease progresses to critical limb ischemia leading to gangrene, dead tissue. Amputations can include above-the knee, below-the-knee, or partials. Orthopedic surgeons and vascular surgeons who specialize in the treatment of people with PAD and different types of tissue loss may perform these surgeries. Podiatrists perform most below -the-knee amputation. Amputations can also be done to remove parts of an extremity that have been affected by the damage, such as gangrene or a burn.
What lifestyle changes can you do to decrease peripheral arterial disease?
By modifying risk factors, you can decrease PAD progression. Lifestyle changes included stopping smoking, controlling cholesterol, controlling blood pressure, losing weight if you are overweight, and doing moderate exercise.
What medical treatments are there for peripheral arterial diease (PAD)?
Medical treatment aims to make blood less viscous, more fluid. Or medications can dilate the arteries to make more blood flow to your legs. Other medicines the root causes of PAD including high cholesterol and blood pressure.
- clopidogrel is an anti-platelet drug that can be used in PAD although aspirin is usually preferred
- aspirin is a anti-platelet medication often used
- pentoxifylline (Trental) works by opening blood vessels to increase blood flow
- cilostazol (Pletal) works by making blood vessels more flexible and opening up the pathways for blood to get through
- statins are often used to lower cholesterol and can reduce intimal hyperplasia due to endothelial dysfunction.
Imaging & Interventional Specialists offer FDA-approved treatments (non-surgical alternatives) to treat peripheral arterial disease.
Call us now or schedule an appointment to discuss your condition and your options.
What non surgical "pinhole" procedures are available to treat peripheral artery disease (PAD)?
Interventional radiology revolutionized modern vascular medicine by developing methods to place miniaturized specialized equipment into areas of disease using blood vessels as roads. This allows minimally invasive, "pinhole", outpatient surgery. In some cases, it is even possible to perform a surgery using just a tiny catheter. These specialized tools can be used to place stents, drugs or remove blockages from vessels and restore blood flow without large incisions and recovery times associated with traditional open surgery. This "pinhole" procedures restore the artery's ability to carry blood to the limbs.
The main "pinhole" procedures used to treat PAD are:
- angioplasty: inflating a tiny balloon - that may be drug coated- inside you artery
- stent placement: which may be drug eluting
- atherectomy: a miniaturized tool used to remove material blocking the artery
Advanced revascularization techniques include:
- bioresorbable scaffolds which may be drug-eluting
- vascular tacks
What is angioplasty?
A balloon angioplasty is a nonsurgical technique that widens the arteries by inflating a tiny, flexible tube called a balloon inside the artery. Using a tiny catheter, the narrowed area is accessed and then a balloon is introduced. This balloon may be drug coated. A drug coated balloon is a catheter system that uses a balloon coated with a drug to open up the narrowed artery and allow blood flow into the leg arteries. The drug is an anti-proliferative medication which aim to help prevent restenosis – re-narrowing of the artery. Drugs include paclitaxel or sirolimus.
What is stent placement?
Stenting is often an effective treatment used to relieve arterial narrowing caused by PAD. A metal mesh or expandable-metal stent acts like scaffolding or small pipes to keep the artery open. A stent is permanent and over time the lining of your arteries grows over it. On rare occasions, complications after stenting may include restenosis (recurrent narrowing in the artery), which can occur months later when scar tissue forms around the stent. This process involves building new cells in the artery wall.
Stents can be:
- self-expanding
- balloon expandable
- drug eluting
Self-expanding stents are made from a metal mesh tube which expand as they are release into the artery at the precise area of narrowing.
A balloon expandable stent is a stent compressed over a balloon. By filling the balloon with contrast, it can be seen on x-ray and therefore deployed precisely.
Drug eluting stents delivery an anti-proliferative medication to prevent restenosis (recurring narrowing). These medications include paclitaxel, sirolimus or everolimus.
What is atherectomy?
Atherectomy is a minimally invasive procedure that removes plaque from blood vessels, allowing them to open and improve blood flow. Atherectomy uses a tiny rotating metal shaft with cutting blades to shave away deposits of fatty material or plaque in the arteries. A catheter containing an atherectomy device is inserted through a small puncture into an artery and advanced into place. The atherectomy devices can remove soft areas of plaque and even calcified tissue. Contrast this with balloons or stent that press on the plaque to open the artery to increase blood flow.
What are advanced revascularization techniques?
Revascularization is the process of reestablishing blood flow through the diseased blood vessel. A CTO is a chronic total occlusion when there is a complete or nearly complete blockage of one or more arteries usually for more than 3 months. Besides peripheral arterial disease these can be a part of carotid artery disease and coronary artery disease.
Chronic total occlusions of leg arteries cause reduced blood flow and puts you at increased risk of critical limb ischemia and severe PAD.
Advanced revascularization including the SAFARI technique that way be combined with tibial retrograde techniques.
The “SAFARI” technique, or subintimal arterial flossing with antegrade-retrograde intervention, is a method for recanalization of chronic total occlusions (CTOs) when subintimal angioplasty fails.
Retrograde tibial techniques can be helpful if the CTO intervention fails and uses tiny catheters to approach diseased vessels from the feet.
What are some new, cutting edge "pinhole" treatments for PAD?
New methods for treating peripheral artery disease include bioabsorbable stents, bioabsorbable scaffold that may elute drugs and vascular tacks.
Bioabsorbable stents and scaffolds are designed to be deployed by "pinhole" techniques and hold open the narrowed artery then be dissolved away by your body over time. Drug eluting stents and scaffolds leak out an anti-growth medicine that inhibits the artery from narrowing again.
Vascular tacks are short nitinol (an alloy of nickel and titanium) cylinders that hold open your artery. These newer techniques have particular use in infra-popliteal or below the knee peripheral artery disease commonly occurring in diabetics.
How do Imaging & Interventional Specialists diagnose peripheral artery disease (PAD)?
Imaging & Interventional Specialists will begin with a history and physical exam. They will ask about risk factors like high blood pressure, smoking, diabetes and heart disease.
What tests do Imaging & Interventional Specialist use to diagnose peripheral artery disease (PAD)?
Imaging & Interventional Specialists may order noninvasive tests to diagnose PAD including:
- Doppler Arterial Vascular Ultrasound to measure waveforms and pressures in the legs
- Ankle brachial index (ABI) – blood pressure measurements in the arms and legs to find out how bad your PAD is
- Treadmill test
- Magnetic Resonance Angiography, CT Angiogram where pictures of you arteries are taken after injecting special dye
- Pulse Volume Recording or PVR Scan
If needed lower extremity angiography (LEA) can be performed either to confirm diagnosis and to plan for an intervention or as part of a "pinhole" procedure to address your peripheral artery disease (PAD).
What advanced, non-surgical, "pinhole" procedures do Imaging and Interventional Specialists use to treat peripheral artery disease?
Imaging & Interventional Specialists will evaluate whether you are a good candidate for minimally invasive. "pinhole" procedures to treat your PAD or whether lifestyle changes, medicines or surgery is a better option.
The revascularization techniques that may be used include:
- angiograms
- angioplasty
- stent placement (that may include drug eluting stents)
- atherectomy
- dvanced techniques: SAFARI, scaffolds and tacks
Imaging and Interventional Specialists "pinhole" procedures: Fast recovery, Less Pain, Less Risk
Our seasoned, world class, board-certified specialists successfully perform “pinhole” procedures every day. We perform this region’s leading, state-of-the-art solutions to peripheral arterial disease. Our minimally invasive image guided procedures are cutting edge technology without the cutting! Without the scalpel! You leave with a Band-Aid! Advantages include
- rapid recovery
- fewer side effects
- less complications
- less risk
- can be performed in an outpatient setting without being “put to sleep”
- go home the same day with a Band-Aid
WHY IMAGING & INTERVENTIONAL SPECIALISTS?
Imaging & Interventional Specialists perform world-class, minimally invasive, "pinhole" procedures every day that will cure or minimize your peripheral arterial disease Using state-of-the-art equipment, our seasoned board-certified specialists will strive to produce the best outcome for your peripheral arterial disease.
