Peripheral Intervention

Peripheral artery disease (PAD) or peripheral vascular disease refers to a circulatory problem wherein narrowed arteries are unable to supply sufficient blood to the extremities (mainly limbs). In this medical condition, plaque accumulated in the arteries (carrying blood to different organs of the body, such as head, limbs, heart, etc.) obstructs the blood flow and, in some cases, may also cause blood clots and hence blocks the blood vessel completely. The plaque is made of cholesterol, calcium, fibrous tissue, fat, and various other elements in the blood.

At present, PAD affects a large percentage of the general population and is a regular problem amongst people with high blood cholesterol levels.[1]

Peripheral Artery Disease Symptoms

Even though many people with PAD disease may experience mild or no symptoms, in certain cases people may feel some cramping or pain in the arms/legs after taking a long walk. Other symptoms include:

  • Bad or painful cramping in thigh muscles, calves, or hip areas post certain physical activities like a long walk or running, or climbing stairs
  • Weakness/numbness in leg
  • Coldness in the lower foot/leg
  • Sores on foot/leg/toes that rarely heal
  • Alteration in the color of legs
  • Excessive Hair loss or sluggish hair growth on legs/feet
  • Toenails grow very slow
  • Weak/no pulse in feet/legs
  • Erectile dysfunctionality in males
  • Intensive pain experienced during sleep

Peripheral Artery Disease Treatment

Following are the ways used by doctors to treat peripheral artery disease:

  1. Bypass Grafting

This technique is used by a heart doctor if the blood flow to a patient’s limb is partially or entirely blocked. In such a situation, a doctor may either use a synthetic tube or the patient’s blood vessel from a different part of his/her body to make a graft. The graft then bypasses the blocked section of the artery and restores the blood flow. While the surgery is not effective in curing the Peripheral Artery Disease, it may foster the blood flow to the affected area.

  1. Peripheral Vascular Interventions

It is a procedure wherein a thin, small, and a flexible hollow tube known as “catheter” is inserted into the body vessel via a small cut (mainly in the arm or leg), and is advanced to the site of the disease. Once a catheter reaches the required place, it serves as a tunnel that can be used by a physician to proficiently direct the surgical tools to required areas and perform medical procedures on the affected artery or vein[2]

If an artery is blocked by a plaque, the muscles and soft tissue may not be able to function properly due to the deficiency of nutrients and oxygen required to work. As a result, a person may experience numbness or pain in the limb and may even require amputation. In such cases, the use of the catheter may facilitate doctors to sidestep making big surgical cuts while removing the plaques or blockage. This, in turn, causes relatively less pain to patients along with acquiring low risks of infection, accelerating recovery time, and avoiding big scars on the body.

  1. Angioplasty Procedure & Stenting

Angioplasty refers a non surgical medical procedure, which is performed by doctors to open the blocked arteries. Likewise, stent placement is an alternative procedure, usually performed during an angioplasty.

During angioplasty, a doctor uses a catheter to direct a small and unfilled balloon to the location of the blockage. Subsequently, the balloon is pumped to press the plaque tightly against the artery wall, thereby widening the artery and improving blood flow to the heart muscles, without any obstruction.

Post angioplasty, a surgeon may place a stent (a minute mesh tube) into the area of blockage to push the artery wide-open. [3]

  1. Atherectomy

This technique is similar to angioplasty, with the exception of using distinct tools (blades) for removing plaque formed in the artery wall.

This means, the procedure makes use of a catheter for directing a minute device with small blades to accurately shave or remove the plaque blocking the artery wall. More often, doctors use laser technique to blow-up plaque into tiny pieces that easily becomes soluble in the blood. The approach is commonly appreciated as after the completion of this procedure, it leaves no medical device/instrument in the patient’s body. Besides, the procedure takes from 30 minutes to few hours only for completion and the patients experience low pain and discomfort due to use of anaesthesia.

Nevertheless, this technique is performed only in certain cases whereby a doctor needs comfort of a device to open-up a narrow/blocked artery. Some of the potential side effects of this surgery include allergic reactions to dyes and medicines used during the process, irregular heartbeats, infection and bleeding risks, heart stroke, or brain damage.

References:

1. Cummins P, Serruys PW. Peripheral vascular disease: shaping a new panvascular interventional approach. EuroIntervention : journal of EuroPCR in collaboration with the Working Group on Interventional Cardiology of the European Society of Cardiology 11(7): 729, 2015

2. White CJ. A “win-win” for peripheral vascular intervention. JACC Cardiovascular interventions 4(6): 702-3, 2011

3. Calvet D, Mas JL. Recent advances in carotid angioplasty and stenting. International journal of stroke : official journal of the International Stroke Society 11(1): 19-27, 2016

4. Kret MR, Dalman RL, Kalish J, Mell M. Arterial cutdown reduces complications after brachial access for peripheral vascular intervention. Journal of vascular surgery, 2016