PERIPHERAL ARTERIAL DISEASE MANAGEMENT

WHAT IS PERIPHERAL ARTERIAL DISEASE?

Peripheral arterial disease (PAD) damages your arteries, which are blood vessels that deliver blood from the heart throughout the body. Peripheral arterial disease, which occurs in various forms, is present when the arteries to your arms or legs narrow or become clogged. This most often results from hardening of your arteries or atherosclerosis. In the lower extremities, ischemia can cause claudication (a term used to refer to impairment in walking, or pain, discomfort, numbness, or tiredness in the legs that occurs during walking or standing and is relieved by rest) in peripheral artery disease (PAD) or may cause critical limb ischemia (CLI) in severe cases.

WHAT ARE THE SYMPTOMS OF PERIPHERAL ARTERIAL DISEASE?

Some people experience pain or heaviness in their legs while walking, which prevents them from enjoying their lives. Aching, throbbing legs

• Pain and cramping
• Numbness
• Tingling
• Weakness
• Burning
• Discoloured skin

You may be more likely to have PAD if (among other factors), you have High cholesterol, High blood pressure, diabetes or a history of smoking. Interventional radiologist can help determine if you have PAD through a simple test called an ankle brachial index test, or ABI, that compares the blood pressure in the upper and lower limbs or an examination using imaging techniques such as ultrasound, CT and MRI.

The most common types of PAD include blood clots or atherosclerosis, a disease in which plaque, a sticky substance made up of fat, cholesterol, calcium, and other substances found in the blood, builds up inside your arteries. The plaque blocks blood flow and prevents oxygen from reaching tissue. This can cause pain, sores, or even dead tissue that can lead to strokes and heart attacks.

HOW DO WE TREAT PERIPHERAL ARTERIAL DISEASE?

If lifestyle changes aren’t enough to treat your PAD, you might benefit from a minimally invasive interventional radiology treatment. In most cases, the Interventional Radiologist will do a pin point puncture in the groin and will guide catheter through your blood vessels to the blockage or narrowed artery. Depending on where the blockage is and how it looks, it may be treated it in several ways.

THROMBOLYSIS

Thrombolysis, which is usually enacted in an emergency because the body has not had enough time to respond by growing new blood vessels to bypass the blockage, is a treatment that delivers medication slowly, over 12-24 hours, to a blood clot through a thin tube that is inserted next to or within the clot. You’ll be hospitalized during the treatment and will be watched by doctors. Often, the clots will dissolve but the artery will still be narrowed, and additional treatments may be required.

THROMBECTOMY

When a blood clot suddenly blocks blood flow, a treatment known as a thrombectomy will remove the clot from the body using various medical tools that can draw out, pull out, or vaporize the clot.

ANGIOPLASTY

Angioplasty uses inflatable devices called balloons to open up narrowed arteries. Various types of balloons are used in different situations, including balloons that stretch arteries open, metal-edged balloons that cut and break up calcium deposits, and drug-coated balloons that can prevent scarring and future narrowing of the artery. During angioplasty, the interventional radiologist guides a catheter with a tiny balloon tip through the blood vessels into the blockage. The balloon is inflated to widen the artery, which restores blood flow.

STENTING

Sometimes, following balloon angioplasty, the doctor will place a stent (a tiny mesh tube) in the artery to help keep it open. Those who receive stents will also need to be on clot-preventing medications to reduce the chance of clots forming inside the stent.

WHY PERFORM IT?

This procedure may be beneficial for you if you suffer from leg pain when walking (intermittent claudication) or if you have a restricted blood supply in your legs (leg ischaemia) as a result of diabetes. The angioplasty and stenting procedure can also be a treatment for peripheral arterial disease.

Angioplasty and stenting is a way to restore blood flow, relieve pain caused by restricted blood flow.

WHAT ARE THE RISKS?

The success rate of the procedure is usually around 90-95%, though it varies according to the extent and complexity of the blockages in the artery. The majority of patients experience significant clinical improvement, meaning that their pain decreases and any wounds in the area heal better.

In around 10-15% of cases (the rate depends on the location and particular structure of the artery), the affected artery becomes blocked again, known as restenosis. If this happens to you, your symptoms will return and you will need to be treated again.

Minor complications are unusual but include bleeding, bruising and infection. It is possible that the artery will be damaged by the balloon, causing the vessel to rupture, in which case the interventional radiologist will place a covered stent in the vessel to control any bleeding.

Although the interventional radiologist will do all they can do minimise the risk of an allergic reaction, there is a risk of a reaction to the dye used in the imaging technique.

WHAT CAN I EXPECT DURING TREATMENT?

Once the treatment is completed, the catheter is removed and pressure is applied to the tiny pin point opening in your groin to allow it to heal. You will then lie flat on your back for several hours. Usually, you will be able to go home the same day, but there is a small chance you will be observed overnight and discharged in the morning.