Interventional Radiology :: Procedures :: Vascular :: Angioplasty and Stenting-PVD
Procedures & Treatments
 
Procedures Vascular Angioplasty and Stenting-PVD
 
About the Procedure

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Peripheral vessels  include all the blood vessels that supply the limbs and organs of the body other than the heart.

 As one grows older, these vessels tend to slowly get narrow ,secondary to fat and fibrous tissue deposition . At times these areas also collect calcium.

This disease process gets accelerated in diabetics , patients with increased blood lipids and smokers. In addition  certain individuals are genetically prone to develop these changes at an earlier age.
Interventional procedures have revolutionized the management of peripheral vascular disease with the help of balloons' and stents.
Procedure Details

Peripheral Vascular Disease( PVD)
Peripheral vessels  include all the blood vessels that supply the limbs and organs of the body other than the heart.
 As one grows older, these vessels tend to slowly get narrow ,secondary to fat and fibrous tissue deposition . At times these areas also collect calcium.
This disease process gets accelerated in diabetics , patients with increased blood lipids and smokers. In addition  certain individuals are genetically prone to develop these changes at an earlier age.
The symptoms of PVD (Peripheral Vascular Disease)   is seen in the region supplied by the blood vessel beyond the site of narrowing. Thus when the vessel of the limbs are narrowed, one develops pain in the limb when it is in use ,this pain is relieved with rest .When the disease progresses further  it produces  pain even at rest .
Left alone ,the disease may progress  further and the patient may develop ulcers that do not heal . When the Blocks are sudden or extensive the leg changes color and finally the skin and muscle will die and this is called gangrene . Once gangrene sets in then  the only treatment available will be amputation which may either be limited to the  area involved  or at times the leg, either below or above the knee joint.
Medical Management
Risk factor modification continues to be the cornerstone of medical management. Smoking is a major risk factor and should be discontinued at  all cost. The Sugar levels and Lipid profiles have to  be kept under good control .In addition patients should be encouraged to take  exercise, in the form of walking, for about 45 minutes. 
Data studies suggest that Aspirin alone or combined with Clopidogrel, will delay the progression of established arterial  disease .
However, often medical management may not relieve the problem of pain and  ulceration and adequate blood flow has to be established to help salvage the limb. 
 Blood supply can be re-established to the leg by a minimally invasive technique—angioplasty or by a surgical by-pass. However, the choice of treatment can only be decided after doing an Angiogram of the affected limb.

Angiography
Angiography is performed in a theater with specialized imaging equipment. It is performed under local anesthesia   where an injection is given either in the arm or in the thigh . A medical dye is then injected through a small tube ( catheter) and images recorded. The images are then analyzed to plan further treatment .
Angioplasty and Stenting
When the length of the block is not long,angioplasty is the preferred choice. Angioplasty is in many ways similar to angiography. It is performed in the same theater under local anesthesia where a wire is used to cross the block in the blood vessel, after which a balloon is taken across the block and inflated. A few seconds later it is deflated and removed. An Angiogram is then taken to confirm  the results. At times the results may not be adequate and the vessel may require further treatment  by supporting the segment with a special tubular metal  mesh called Stent.
Following the procedure the tubes are taken out from the site of puncture   and compression given   for a few minutes to stop the bleeding. The patient is advised to keep the leg that was punctured straight for 6 – 8 hours. Often the puncture sight may be closed with a closure device and the patient is allowed to walk after an hour.The patient may be on I.V. or other form of medication which requires hospitalization for a few days.If they have a wound, then wound care may also require them to be hospitalized
Following the procedure you will be asked to continue medications, many of them lifelong.It is mandatory that you never smoke again and all contributory factors of PVD are kept at the minimum like diabetes and lipid profile.Regular follow up with the doctor is important as the disease can recur either at the same site or at a different one.
Complications
Though rare any vascular interventional procedure carries the following risks.
1. The procedure may fail and one may have to resort to surgery. 
2. The vessel may re-occlude following the procedure and may require surgical interventions or specialized drug therapy.
3. The leg may get worse due to clot passing into the small vessels and may even result in amputation. 
4. Drugs including the dye used for angiography can produce an allergic reaction which can rarely be severe and dangerous to life. 
5. In about 10-15 % patients the treated area may redevelop a block in future.
 
For further information contact : dr.mathewcherian@gmail.com 
Phone : +91 9600900373,+91 422 2628627
 
Case Study
Bilateral Iliac Angioplasty
 
 
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