Peripheral Vascular Disease (PVD), also known as Peripheral Arterial Disease or PAD, involves damage to, or blockage in, the peripheral blood vessels located away from the heart, including those that supply blood to the head, neck, brain, abdomen, and legs. The first line of prevention and treatment for PVD involves adopting lifestyle changes to lower your risk for heart disease and stroke. Your doctor may treat PVD by using medications that address risk factors. When more conservative treatment options don't work, procedures using catheters, balloons, and stents as well as surgery may be necessary.
Diagnostic Peripheral Angiography
A peripheral angiogram or arteriogram is an examination of the peripheral arteries in your body. Peripheral angiograms are most often done to examine the arteries that supply blood to the head and neck or the abdomen and legs. Because arteries do not show up on regular x-rays, angiograms use a contrast dye that is injected into the arteries to make them visible under x-ray and show where blood flow may be blocked.
Peripheral angiograms are done under local anesthesia. You will have an intravenous (IV) catheter placed in your arm and you may be given a mild sedative. The procedure takes from one to three hours, and there will be time after the procedure during which you will be closely monitored. Many people can go home after the procedure, but some need to stay in the Hospital overnight for additional monitoring after an angiogram.
Interventional Peripheral Procedures
A peripheral interventional procedure may be required if your doctor finds you have a blocked or partially blocked peripheral artery. Several interventional procedures are used to open the artery.
- Balloon Angioplasty (Percutaneous Transluminal Coronary Angioplasty or PTCA)
A balloon-tipped catheter is inserted to where you have the blockage. Once in position the balloon on the catheter is inflated several times. The material responsible for the blockage (plaque) is compressed against the walls of your artery, opening the blockage and improving blood flow through your artery.
- Balloon Angioplasty with Stent
During a balloon angioplasty, your doctor may place a stent (a small, metal mesh cylinder) in your artery. There is substantial evidence that stents help to keep the artery open long-term. After the balloon has been inflated, your doctor will insert the stent inside your artery. The stent remains in your artery permanently and is designed to prevent the artery from narrowing again.
- Peripheral Atherectomy
A catheter with a burr device (rotating shaver) on the end is inserted into the artery to the area of narrowing or blockage. The substance causing the narrowing or blockage (plaque) is removed from the artery. Peripheral atherectomy is sometimes done in conjunction with peripheral angioplasty or balloon angioplasty with stent.
- Peripheral Laser Angioplasty
A thin flexible catheter with a laser at the tip is inserted into the artery to the area of narrowing or blockage. The laser emits pulsating beams of light that vaporize the substance causing the narrowing or blockage. Laser angioplasty is sometimes done in conjunction with balloon angioplasty.
- Carotid Artery Stenting
Carotid arteries supply blood to the brain. When a carotid artery becomes partially or fully blocked (carotid stenosis) with fatty deposits or plaques, blood flow to the brain is compromised. Carotid stenosis is a risk factor for stroke or transient ischemic attack (TIA) of the brain.
Carotid artery stenting is an interventional procedure in which a stent is placed in your carotid artery in order to keep the artery open and reduce your risk of stroke. Unlike carotid artery surgery, which requires an incision in your neck to open the carotid artery and remove the blockage, carotid artery stenting is done in the cardiac catheterization laboratory (Cath Lab) under local anesthesia by an interventional cardiologist or vascular surgeon. Just as with other angioplasty procedures, a catheter is placed in a vessel in the groin and advanced into the carotid artery under x-ray guidance.
Following the procedure, you will need to spend the night in the Hospital. You will be cared for and monitored by a team of specially trained registered nurses, nurse practitioners, cardiovascular technologists, and doctors during your procedure in the cardiac catheterization laboratory and in our CardioVascular Unit (CVU) following the procedure.
- Thrombolytic Therapy (Pharmaceutical Thrombolysis)
Thrombolysis is a process to break up a blood clot. Thrombolytic therapy uses medication to attempt to dissolve blood clots that are obstructing an artery. The medication (a thrombolytic) is administered directly into the clot through a catheter that has been placed into the artery obstructed by the clot. The catheter may be left in place for several hours or up to several days in order for the clot dissolving medication to work. Typically, you are admitted to the Hospital after the catheter has been placed, and it is common to be in the Intensive Care Unit (ICU) where you can be closely monitored.
- Thrombectomy (Mechanical Thrombolysis)
Thrombectomy is a procedure used to break up and remove a blood clot that is causing full or partial obstruction of blood flow in an artery. A catheter with a device attached is inserted into the obstructed artery. The device shoots high-speed jets of salt solution through small openings in the tip of the catheter to break up the clot. The clot pieces are then vacuumed back through the catheter and removed.