Interventional Treatment of Peripheral Vascular Diseases
Peripheral artery disease (PAD) refers to a group of disorders affecting the iliac, femoral, popliteal, and tibial arteries. If one or more of these arteries become narrowed or blocked, it can lead to serious circulation problems in the legs and feet. PAD is a type of cardiovascular disease, most commonly caused by atherosclerosis.
Atherosclerosis is a natural aging process affecting blood vessels throughout the body, but certain factors can accelerate this process, causing early narrowing or blockage in some arteries. Fat particles, cholesterol, calcium, other substances, and some blood cells can accumulate on the artery walls, forming hardened plaques called atherosclerotic plaques. Over time, these plaques can grow, narrowing the artery (see Image 1) and potentially leading to complete blockage (see Image 2). Irregular surfaces of these plaques can also cause blood clots, suddenly blocking the artery entirely.
When a blocked artery cannot deliver sufficient blood to tissues, the affected tissues are deprived of oxygen, leading to various problems and symptoms. Other important factors causing poor circulation in tissues include diabetes and Buerger’s disease, which often develops due to smoking and primarily affects arteries in the legs.
What Should Alert Us?
Atherosclerosis develops silently over many years without showing obvious symptoms. When the narrowing of an artery reaches a certain degree (usually more than 50%), symptoms start to appear depending on the area supplied by the affected artery.
The most common symptom in peripheral artery disease (PAD) is intermittent claudication. Patients experience cramp-like pain in the hip, thigh, or leg after walking a certain distance. The pain becomes so intense that the patient must stop walking. After resting for a while, the pain subsides, allowing the patient to continue walking, but it reappears after a short distance, requiring another rest. The shorter the pain-free walking distance, the more severe the condition. The pain occurs because physical activity increases oxygen demand in the leg muscles, but the narrowed artery cannot deliver sufficient blood to meet this need.
Due to inadequate blood flow, the affected leg often feels cold. In advanced stages, hair loss on the legs and muscle thinning due to atrophy can be observed. A more severe stage is rest pain, where patients cannot sleep because of constant leg pain and often try to relieve it by hanging their legs off the bed. The final stage is the appearance of foot ulcers, usually on pressure-prone areas like the toes and heels. These wounds fail to heal due to insufficient blood supply, and in some cases, the condition may progress to limb loss.
Surgical Treatment
Medication for peripheral artery disease typically includes blood thinners and drugs that help dilate small blood vessels. If a patient’s pain-free walking distance is satisfactory for daily activities, medication is the first-line treatment.
However, if the pain-free walking distance limits the patient’s daily activities or if the patient experiences rest pain, interventional or surgical treatment becomes necessary. The first choice is usually endovascular therapy. In this method, after imaging the patient’s vascular system in an angiography lab, the narrowed or blocked segment is widened with a balloon, and usually an intravascular stent (metallic scaffold) is placed. The location and diameter of the affected artery are key factors in deciding the treatment approach.
If the patient is unlikely to benefit from endovascular treatment, or if multiple arteries are narrowed or blocked, surgical bypass is planned. In bypass surgery, the patient’s own vein (saphenous vein) or synthetic grafts (Dacron or PTFE grafts) are used as bypass conduits. The choice depends on the patient’s age, disease severity, and the likelihood of future cardiac surgery.
After surgery, patients usually stay in the cardiovascular intensive care unit for 2–3 hours, and rarely for one day. If there are no complications related to the surgery or the patient’s general condition, they are transferred to a regular hospital room and discharged home with recommendations for continued rest, usually within 5–7 days.
Interventional Treatment of Peripheral Vascular Diseases
Peripheral artery disease refers to a group of disorders affecting the iliac, femoral, popliteal, and tibial arteries.
Interventional Treatment of Peripheral Vascular Diseases
Peripheral artery disease (PAD) is a type of cardiovascular disease and is primarily caused by atherosclerosis.