VASCULAR & IR

Peripheral Arterial Disease and Renovascular Hypertension

Hardening of the Arteries Is a Red Flag for Vascular Disease

This includes heart attack and stroke.  Peripheral arterial disease (PAD), also known as peripheral vascular disease (PVD), is a very common condition affecting 12-20 percent of Americans age 65 and older. PAD develops most commonly as a result of atherosclerosis, or hardening of the arteries, which occurs when cholesterol and scar tissue build up, forming a plaque inside the arteries that narrows and clogs them, leading to a very serious condition. The clogged arteries cause decreased blood flow to the legs, which can result in pain when walking, and eventually gangrene and amputation. In the renal arteries (the arteries that feed the kidneys), this can cause high blood pressure and renal insufficiency.

 

Symptoms

  • The most common symptom of PAD is called claudication, which is leg pain that occurs when walking or exercising and disappears when the person stops the activity.

  • Other symptoms of PAD include the following conditions on the lower legs and feet: numbness and tingling, coldnes, and constant ulcers or sores.

  • Renovascular Hypertension: Poorly controlled high blood pressure may be caused by narrowing of the renal arteries.

Treatments

  • Lifestyle: Often PAD can be treated with lifestyle changes. Smoking cessation and a structured exercise program are often all that is needed to alleviate symptoms and prevent further progression of the disease.

  • Angioplasty and Stenting: Interventional radiologists pioneered angioplasty and stenting, which was first performed to treat peripheral arterial disease. Using imaging for guidance, they thread a catheter through the femoral artery in the groin, to the blocked artery in the legs or kidneys. Then the interventional radiologist inflates a balloon to open the blood vessel where it is narrowed or blocked. In some cases this is then held open with a stent, a tiny metal cylinder. This is a minimally invasive treatment that does not require surgery, just a nick in the skin the size of a pencil tip.


Balloon angioplasty and stenting has generally replaced invasive surgery as the first-line treatment of PAD. Early randomized trials have shown interventional therapy to be as effective as surgery for many arterial occlusions, and in the past five to seven years, a very large clinical experience in centers throughout the world has shown that stenting and angioplasty are preferred as a first-line treatment for more and more processes throughout the body.

The long-term clinical results of stent placement to treat PAD are comparable to those of aortofemoral artery bypass surgery, with a much lower risk of associated morbidity and mortality. Surgery should be reserved for the rare patient in whom stenting cannot be done or fails.