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Peripheral Artery Disease (PAD)

Understanding Peripheral Artery Disease (PAD)

Peripheral artery disease (PAD) is a condition characterized by the narrowing or blockage of arteries located outside the heart or brain. Typically, PAD is a consequence of a process known as atherosclerosis, where fatty deposits, referred to as plaques, accumulate within the walls of your arteries. This buildup can primarily affect the arteries in the legs.

How Atherosclerosis Leads to PAD:

Atherosclerosis occurs as these plaques continue to accumulate, causing the arterial walls to constrict. This narrowing of the arteries can ultimately restrict or completely block the normal flow of blood. It's important to note that PAD is not limited to the legs, but it often affects the lower extremities to a greater extent.

Certain factors that may place you at risk for peripheral leg artery disease include:

  1. Smoking

  2. Diabetes

  3. Obesity

  4. Hypertension or High blood pressure

  5. Hyperlipidemia or High cholesterol

  6. Aging, primarily age 50 and older

  7. A family member who has peripheral artery disease or heart disease

  8. A family member who has had a stroke

  9. Above normal levels of homocysteine, a tissue-building protein

Atherectomy decreases the amount of plaque which leads to peripheral arterial disease

Critical Limb Ischemia (CLI):

In severe cases of PAD, particularly in its most advanced form known as Critical Limb Ischemia (CLI), the risk of amputation is estimated to be around 25%. CLI is characterized by severely restricted blood flow to the extremities, leading to tissue damage and a heightened risk of limb loss.

Mesenteric Ischemia Treatment

 

Mesenteric ischemia is a specific form of Peripheral Artery Disease (PAD) characterized by the narrowing or blockage of the arteries that supply blood to vital organs like the liver, stomach, intestines, and colon. This reduction in blood flow can lead to poor circulation within these organs, potentially compromising their normal function.

Symptoms of Mesenteric Ischemia:

In chronic cases of mesenteric ischemia, patients often experience symptoms such as unexplained weight loss and abdominal pain, particularly following meals. These symptoms are indicative of compromised blood flow to the abdominal organs during digestion.

Treatment Approaches:

The choice of treatment for mesenteric ischemia depends on whether the condition is sudden and acute or ongoing and chronic.

  • Acute Mesenteric Ischemia: In cases of acute mesenteric ischemia, where the condition requires immediate attention, medical intervention is crucial. Rapid diagnosis and appropriate management are essential to restore blood flow to the affected organs and prevent severe damage.

  • Chronic Mesenteric Ischemia: For chronic mesenteric ischemia, where the condition persists over time, minimally invasive endovascular treatments such as angioplasty and stenting have become the preferred approach. These procedures help to open narrowed arteries, restore blood flow, and alleviate symptoms without the need for more invasive surgical methods.

Treatment Options for Peripheral Arterial Disease 

At Houston Vein and Vascular, we are committed to providing comprehensive care for patients with Peripheral Arterial Disease (PAD). Our goal is to offer personalized treatment solutions that improve blood circulation, alleviate symptoms, and enhance overall quality of life. Here are the treatment options we offer:

1. Lifestyle Changes:

We believe in the power of lifestyle modifications to manage PAD effectively. Our experts guide patients in adopting heart-healthy practices, including quitting smoking, maintaining a healthy weight, following a balanced diet, and engaging in regular exercise to enhance blood flow and cardiovascular health.

2. Medications:

Our medical team may prescribe medications tailored to your specific needs, including:

  • Antiplatelet drugs to reduce the risk of blood clots.

  • Cholesterol-lowering medications to manage plaque buildup.

  • Blood pressure medications to control hypertension.

  • Symptom management drugs to alleviate leg pain and discomfort.

3. Minimally Invasive Procedures:

When needed, we offer minimally invasive procedures to restore blood flow:

  • Angioplasty: This minimally invasive procedure involves inserting a catheter with a balloon into the narrowed artery. The balloon is then inflated to widen the artery, improving blood flow and alleviating blockages. Angioplasty is a highly effective method for restoring blood flow and relieving symptoms.

  • Atherectomy: Atherectomy procedures involve the use of specialized devices to remove plaque from the artery walls. This process restores the artery's natural diameter, enhancing blood flow and reducing the risk of future blockages. Atherectomy is particularly beneficial for patients with heavily calcified or complex plaques.

  • Stenting: In some cases, a stent, a small mesh tube, may be inserted during angioplasty to help keep the treated artery open. Stents provide ongoing support to the artery, preventing it from collapsing or narrowing again. They are especially useful in cases where the artery is at risk of re-narrowing (restenosis) after angioplasty.

Deep Venous Arterilization or LimFlow procedure

Deep Venous Arterilization (DVA) or artriovenous reversal is typically a last resort type treatment to prevent major amputation during limb salvage treatment. DVA involves converting one of the veins in the legs into an artery by performing a percutaneous or minimally inavsive bypass of the artery to vein. Patients who qualify for DVA are typically suffering from non healing wounds or ulcers and have undergone extensive revascularization procedures. When arterial procedures fail, DVA becomes a great treat option to saves limbs and prevent amputation. Most often, the posterior tibial artery is connected to the posterior tibial vein and this connection is secured using stents. This allows blood to the reach the capillary bed in the foot via the veins and reverses how the capillary bed and tissue is being perfused (receiving blood flow). 

After undergoing a DVA or deep venous arterialization, patients develop swelling, warmth and pain in the foot. This subsides significantly in 4-6 weeks following the procedures. This procedure has been showing to decrease major amputation risk by 58-84%.

At Houston Vein and Vascular, Dr. Zarghouni has been performing Deep Venous Arterilization (DVA) for the patients who have no other revascularization options in order to save their limbs. 

Catheter Directed Thrombolysis and Thrombectomy

Minimally invasive techniques that use tPA, a clot buster drug, and sometimes a mechanical device to dissolve and remove abnormal blood clots.

Advantages of Endovascular Procedures versus Surgery

- Endovascular techniques such as atherectomy, angioplasty and stenting are less invasive options carrying lower risk, and lower cost procedures when compared to surgical interventions such as bypass surgery
- Vast majority of patients do not require general anesthesia.
- No surgical incision is needed, only a small skin nick that does not require a stitch
- Little to no downtime for recovery.

What to Expect from the Procedure

When you come in for your procedure, you will either have local anesthesia with sedation, or general anesthesia – whatever you and your vascular doctor have discussed. Using image guidance your doctor will insert a catheter into the artery through a small incision. The catheter tip has a sharp blade on the end to remove or dissolve plaque from the blood vessel and is designed to collect the removed or dissolve plaque. The process can be repeated to remove a significant amount of disease from the artery, eliminating a blockage from atherosclerotic disease.

Recovery

Atherectomy is usually performed as an outpatient procedure and typically lasts about an hour. After your treatment, you will rest in our recovery area for a while before being sent home. Patients are asked to gradually increase mobility, initially lying flat for a 1-2 hours, then sitting up. Patients are often walking between 2 to 24 hours after the procedure with normal activity being resumed with in 24 to 48 hours.

Procedure Risks

Major complications following angioplasty are uncommon. However, any procedure involving placement of a catheter inside a blood vessel carries certain risks. These include:

- Allergic reactions to contrast or dye

- Breathing problems

- Bleeding

- Blood Clot formation

- Damaged access site

- Infection

- Kidney damage

- Restenosis or recoiling of the vessels causing re narrowing

- Rupturing of artery

Whether or not you are a candidate for interventional or endovascular treatment will depend on your diagnosis and consultation with your vascular doctor. However, if you have been diagnosed with narrowing or blocked arteries or veins and are looking for a safe, minimally invasive option, interventional or endovascular procedures may be the right option for you. Call us today to schedule an appointment for a consultation.

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