Peripheral Arterial Disease:

Is a common circulatory problem in which narrowed arteries reduce blood flow to your limbs.
When you develop peripheral artery disease (PAD), your extremities — usually your legs — don’t receive enough blood flow to keep up with demand. This causes symptoms, most notably leg pain when walking (intermittent claudication).
Peripheral artery disease is also likely to be a sign of a more widespread accumulation of fatty deposits in your arteries (atherosclerosis). This condition may be reducing blood flow to your heart and brain, as well as your legs.

220px-Peripheral_Arterial_Disease

Atherosclerosis is a disease in which plaque builds up in the wall of an artery. PAD is usually caused by atherosclerosis in the peripheral arteries (or outer regions away from the heart). Plaque is made up of deposits of fats, cholesterol and other substances. Plaque formations can grow large enough to significantly reduce the blood’s flow through an artery. When a plaque formation becomes brittle or inflamed, it may rupture, triggering a blood clot to form. A clot may either further narrow the artery, or completely block it.
If the blockage remains in the peripheral arteries in the legs, it can cause pain, changes in skin color, sores or ulcers and difficulty walking. Total loss of circulation to the legs and feet can cause gangrene and loss of a limb.
If the blockage occurs in a carotid artery, it can cause a stroke.
It’s important to learn the facts about PAD. As with any disease, the more you understand, the more likely you’ll be able to help your healthcare professional make an early diagnosis and start treatment. PAD has common symptoms, but many people with PAD never have any symptoms at all.

Risk factors for PAD
• If you smoke, you have an especially high risk for PAD.
• If you have diabetes, you have an especially high risk for PAD.
• People with high blood pressure or high cholesterol are at risk for PAD.
• Your risk increases with age.

Therapies for PAD:

Balloon angioplasty

Interventional cardiologists perform angioplasty, which opens narrowed arteries. They use a long, thin tube called a catheter that has a small balloon on its tip. They inflate the balloon at the blockage site in the artery to flatten or compress the plaque against the artery wall. Angioplasty is also called percutaneous transluminal coronary angioplasty (PTCA).
Although this topic deals with the coronary arteries in the heart, balloon angioplasty can also be used to open narrowed vessels in many other parts of your body. For example, doctors can perform carotid angioplasty to open narrowed carotid arteries, which are the arteries that supply blood to the brain. A stroke most often occurs when the carotid arteries become blocked and the brain does not get enough oxygen. Angioplasty can also be performed in the aorta (the main artery that comes from your heart), the iliac artery (in your hip), the femoral artery (in your thigh), the popliteal artery (behind your knee), and the tibial and peroneal arteries (in your lower leg).

angioplasty

Stenting

Angioplasty is often combined with the permanent placement of a small wire mesh tube called a stent to help prop the artery open and decrease its chance of narrowing again.

fig16_stent1_3

Supera

Atherectomy:
Is the removal of atherosclerotic plaque through different techniques. It can be used by itself “stand alone’ or coupled with balloon angioplasty and stent.

Rotational atherectomy:

Rotational atherectomy involves inserting a small drill into the coronary arteries to grind up plaque and increase blood flow through the vessel.

LASER Atherectomy:

A small fiber optic catheter, connected to the excimer laser unit, is positioned at the top of the blockage, or occlusion, in the artery. When the catheter reaches the occlusion, it starts transmitting short, pulsed bursts of ultraviolet energy through the catheter, penetrating the blockage.

Excisional Atherectomy:

The excision device has a blade that slices the plaque as it advances, then packs the material in a nose cone. Once the plaque excision is complete, the device is removed and the nose cone is cleaned outside of the body.

Jetstream Atherectomy:

This device uses a rotational system alongside saline infusion and aspiration, making it a great tool for removal of clot and large amounts of plaque.

Chronic Total Occlusions (CTO):

CTO is a big challenge when treating PAD. A CTO is a segment that is 100% blocked. The longer the blocked segment and the longer it has been blocked, the more difficult it is to reopen.
The latest technology we have acquired at St Bernards Heart and Vascular to treat CTOs utilizes OCT (Optical Coherence Tomography).
OCT is an imaging modality tha works as an optical ultrasound with high resolution on tissue morphology (higher than MRI or Ultrasound).
The catheter uses OCT to guide the physician in the process of crossing these difficult lesions. This device is called Ocelot.

Using the same OCT technology a new atherectomy device is being tested in top centers across the US. St Bernards Heart and Vascular is so far the top recruiter for this important trial.

Please take a minute to watch this success story of the successful treatment of a difficult CTO

Our physicians at St Bernards Heart and Vascular will be very happy to evaluate and treat you for PAD. Drs Barry Tedder, Jack McKee, Roger Hill, Ammar Al-Hallak, Abelardo Martinez, Jack Havdala and Max Arroyo.