Each month we provide you with
a feature article. This article is authored by one of our
clinicians. Please direct all comments/questions to
info@cdaradiology.com.
Minimally invasive
treatment options for peripheral artery disease - Feature 0608
Peripheral vascular disease (PAD) is the term used to describe
atherosclerotic disease of the arteries supplying the extremities.
Although the term can refer to involvement of any medium or small
vessel, it is usually reserved for arterial vascular disease
involving the legs. Deposition of atherosclerotic plaque in the
vessel walls can lead to blockages and insufficient blood supply to
the legs. This can in turn, lead to pain, weakness, loss of muscle
mass, skin ulcerations and ultimately loss of limb, if flow is not
re-established.
Prevention of the disease can include cessation of smoking, diet
modification and lowering of serum cholesterol with medications such
as the family of drugs called statins (Lipitor, Crestor). Once the
disease is present, these measures are usually insufficient.
Effective treatment requires restoration of blood flow by either
surgical bypass or by less invasive endovascular alternatives.
Minimally invasive trans-catheter endovascular treatments of
peripheral vascular disease include, balloon angioplasty, stent
placement and atherectomy. In cases of severe blockage by thrombus
(clot), thrombolytic drugs can be administered directly into the
thrombus through a catheter in order to dissolve the thrombus. These
procedures are performed by highly trained interventional
radiologists in the interventional department.
Balloon angioplasty involves placing a balloon tipped catheter in an
area of focal vessel narrowing. The balloon is then inflated under
direct x-ray visualization. The balloon expands and stretches the
area of narrowing, creating a larger opening for blood flow. The
stretching process incites a controlled injury to the vessel lining,
allowing it to heal smoothly.
Balloon angioplasty is best suited for short segment stenoses
(narrowing) in specific cases. In other cases, it can precede stent
placement.
Kootenai Interventional Radiology
Endovascular stents are small wire mesh cylindrical lattice supports
that are delivered to the area of vessel narrowing through a
catheter. The catheter is inserted through the groin artery and
guided into position under direct x-ray visualization. The stent is
then deployed at the area of narrowing. The stents can be self
expanding or can be expanded in place with a balloon tipped
catheter. Once deployed, the stent maintains the vessel lumen open,
providing a structured passageway through the plaque. In some cases
several stents can be placed back to back.
Stents are best suited for treating short areas of narrowing in
larger vessels.
Atherectomy devices
SilverHawk atherectomy catheter traversing a stenotic lesion
SilverHawk atherectomy catheter removing plaque
Atherectomy indicates the removal of the plaque. This can be
performed in a minimally invasive fashion utilizing a device
recently introduced by Foxhollow Technologies, Inc. called the
SilverHawk atherectomy catheter. This device is FDA approved for
patient use and has been showed to be extremely effective in the
removal of plaque. The device has the additional advantage of
providing directional control for the removal of eccentric plaque.
The use of this device requires angiographic expertise, and is best
suited for long segments of narrowing and plaque. In the hands of an
expertly trained interventional radiologist, restoration of lumen
diameter and flow can be achieved without the need for surgical
bypass. One year patency rates are upwards of 80%, based on the
TALON study.
SilverHawk atherectomy
Feature Highlight
