Peripheral Vascular Disease (cont.)
Melissa Conrad Stöppler, MD
Melissa Conrad Stöppler, MD, is a U.S. board-certified Anatomic Pathologist with subspecialty training in the fields of Experimental and Molecular Pathology. Dr. Stöppler's educational background includes a BA with Highest Distinction from the University of Virginia and an MD from the University of North Carolina. She completed residency training in Anatomic Pathology at Georgetown University followed by subspecialty fellowship training in molecular diagnostics and experimental pathology.
Daniel Lee Kulick, MD, FACC, FSCAI
Dr. Kulick received his undergraduate and medical degrees from the University of Southern California, School of Medicine. He performed his residency in internal medicine at the Harbor-University of California Los Angeles Medical Center and a fellowship in the section of cardiology at the Los Angeles County-University of Southern California Medical Center. He is board certified in Internal Medicine and Cardiology.
In this Article
- Peripheral vascular disease (PVD) definition and facts
- What is peripheral vascular disease (PVD)?
- Are atherosclerosis and peripheral vascular disease related?
- What are the signs and symptoms of peripheral artery disease (PVD)?
- Who is at risk for peripheral artery disease (PVD)?
- How does atherosclerosis cause disease?
- What are the other causes of peripheral vascular diseases?
- Is there a test to diagnose peripheral artery disease (PVD)?
- What are the management and treatment guidelines for peripheral vascualr disease (PVD)?
- Medications to treat peripheral vascular disease (PVD)
- Angioplasty to treat peripheral vascular disease (PVD)
- Surgery to treat peripheral vascular disease (PVD)
- Which specialties of doctors treat peripheral vascular disease (PVD)?
- What are potential complications of peripheral artery disease (PVD)?
- How can I prevent from getting peripheral vascular disease (PVD)?
- Find a local Cardiologist in your town
Angioplasty to treat peripheral vascular disease (PVD)
Angioplasty, also known as percutaneous transluminal angioplasty, or PTA, is a nonsurgical procedure that can widen a narrowed or blocked artery. A thin tube (catheter) is inserted into an artery in the groin or arm and advanced to the area of narrowing. A tiny balloon on the tip of the catheter is then inflated to enlarge the narrowing in the artery. This procedure is also commonly performed to dilate narrowed areas in the coronary arteries that supply blood to the heart muscle.
Sometimes the catheter technique is used to insert a stent (a cylindrical wire mesh tube) into the affected area of the artery to keep the artery open. In other cases, thrombolytic medications (medications that dissolve blood clots) may be delivered to the blocked area via a catheter.
Angioplasty does not require general anesthesia. Usually, a local anesthetic at the area of catheter insertion and a mild sedative are given. Major complications of angioplasty are rare, but can occur. These include damage to the artery or blood clot formation, excessive bleeding from the catheter insertion site, and abrupt vessel closure (blockage of the treated area occurring within 24 hours of the procedure).
Despite these risks, the overall incidence of complications is low and the benefits of angioplasty (no general anesthesia, no surgical incision, and the ability to return to normal activities within a couple of days) outweigh its risks. Usually a one-night hospital stay is required when angioplasty is performed.
Angioplasty is indicated when a patient has claudication that limits his or her activities and does not respond to exercise, medications, and lifestyle measures. Most doctors also recommend angioplasty when disease is very severe and there is a focal, localized narrowing that is accessible via catheter. If a patient is too ill to have surgery and has severe ischemia (decreased oxygen in the tissues) that threatens loss of a limb, angioplasty may also be attempted.
Some cases of peripheral artery disease may be more difficult to treat by angioplasty. For example, blockages in multiple small arteries of the legs or blockages in extremely small vessels may not be treatable by this method.
Surgery to treat peripheral vascular disease (PVD)
Surgical treatment for peripheral artery disease involves either bypass surgery performed by a vascular surgeon or endarterectomy. Indications for surgical treatment of peripheral artery disease include lesions that, for anatomical reasons, may be difficult to treat by angioplasty. Examples include lesions covering long segments of a vessel, vessels with multiple narrowed areas, or long areas of narrowing. Bypass surgery involves using a vein from your body or a portion of synthetic vessel (known as grafts) to create a detour around the blockage. One end of the graft is sewn to the damaged artery above the blockage and the other end is sewn below the blocked area. Blood flow is then able to bypass the area of narrowing or blockage Bypass surgery is a major surgical procedure requiring general anesthesia and a hospital stay.
Endarterectomy is a procedure in which the surgeon cleans out plaque buildup inside the artery of the affected leg or arm.
Which specialties of doctors treat peripheral vascular disease (PVD)?
A number of different specialists may treat patients with peripheral artery disease. Medication treatment may be managed by internists, family practitioners, or cardiologists. Angioplasty may be performed by interventional cardiologists or interventional radiologists. Vascular surgeons perform some surgical procedures to treat peripheral artery disease.
What are potential complications of peripheral artery disease (PVD)?
In rare cases, the decreased circulation to the extremities characteristic of peripheral artery disease can lead to open sores that do not heal, ulcers, gangrene, or other injuries to the extremities. These areas that do not receive adequate blood flow are also more prone to develop infections and, in extreme cases, amputation may be necessary.
How can I prevent from getting peripheral vascular disease (PVD)?
Peripheral vascular disease related to atherosclerosis can be prevented by minimizing the risk factors that are controllable, such as eating a healthy diet, maintaining a healthy weight, not smoking, getting regular exercise, and maintaining good control of blood sugar levels if you have diabetes.
Stephens, Everett, et al. "Peripheral Vascular Disease." Medscape. Updated: Dec 06, 2015. <http://emedicine.medscape.com/article/761556-overview>.
American Heart Association. <http://www.heart.org>.
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