Peripheral Artery Disease
This is a circulatory condition that involves reduced blood flow to the limbs as a result of narrowed blood vessels. This primarily affects the legs and arms. Symptoms include leg pain when walking, cramping, leg numbness or weakness, coldness in lower legs, pain when using your arms, and more. To treat peripheral artery disease, interventional radiologists perform an angioplasty, an atherectomy, a thrombolysis, a thrombectomy or place a venous or arterial stent.
An angioplasty is a procedure that uses x-ray guidance and a balloon catheter to open a blocked or narrowed blood vessel. By opening a blocked or narrowed blood vessel, blood flow will improve. A catheter will be inserted that will have a balloon over it which is inflated to open the blockage. Occasionally, these balloons will be coated with a chemotherapy agent, or drug-eluding balloons. Sometimes a stent may need to be placed if there is recoil of the blood vessel after the angioplasty.
Arterial Stent Placement
An arterial stent placement, is a self-expanding, mesh metal tube that is placed in a coronary artery. These are sometimes placed after an angioplasty to prevent the artery from closing back up. We will occasionally use balloon-expanding covered stents because they can be stronger than their metal counterparts.
Venous Stent Placement
A venous stent is a small, metal, mesh-like tube that is utilized when there is a blockage due to blood clots or damage to a vessel wall. Prior to a venous stent, an angioplasty is typically attempted. If there is failure of the angioplasty, the venous stent is placed. There are two types of venous stents; balloon-expandable or self-expanding. Some of these stents are bare-metal while others are covered. The appropriate type of stent will be chosen depending on the type of lesion. To insert the venous stent, the balloon placed during the angioplasty is removed and a catheter is inserted with a stent attached to the end. When the stent is placed in the appropriate location, it applies pressure to the walls of the vein to keep it open and allow for better blood flow.
An atherectomy is done by inserting a catheter with a small blade on the end into an artery through a small incision. The small blade is used to scrape away the plaque within the artery. The plaque is collected within a small chamber at the end of the catheter where it can be easily removed from the artery. There are a couple of types of atherectomies including directional and rotational. Typically, we perform rotational atherectomies. We perform a directional atherectomy when we are able to identify exactly where the plaque is sitting using an inter-vascular ultrasound.
Thrombolysis is a catheter-directed procedure that treats blood clots within the arteries or veins and improves blood flow by dissolving abnormal blood clots. X-Ray imaging is used for guidance. A blood clot, also known as a thrombus, can block off blood supply to certain parts of the body, which may cause serious damage. Using the x-ray and a catheter, the doctor is able to direct a special medication or medical device to dissolve the blockage, remove it, or prevent the artery or vein from becoming permanently blocked. Due to the medications used, this procedure may require a longer, overnight stay in the hospital. An overnight stay will also allow doctors to determine the initial cause of the blood clot.
A thrombectomy is a procedure to remove a blood clot from a vein or artery. During this procedure, the doctor will insert a thin catheter into the leg or groin through a small puncture site. The catheter is guided to the blood clot utilizing a contrast dye to locate the blood clot location. A device at the end of the catheter breaks up the blood clot. A thrombectomy in an outpatient setting will take between 2 and 3 hours to complete.