Peripheral Artery Disease (PAD) is a common circulatory problem where narrowed arteries reduce blood flow to the limbs, usually the legs. PAD is often a sign of a more widespread accumulation of fatty deposits in the arteries, a condition known as atherosclerosis. This can lead to reduced blood flow to the heart and brain, increasing the risk of heart attack and stroke. PAD commonly causes leg pain when walking (claudication) and can lead to more serious complications if not managed properly.
The primary symptom of PAD is pain or cramping in the legs or hips during physical activity, which typically subsides with rest. Other symptoms may include numbness, weakness, or coldness in the lower leg or foot, sores on the toes, feet, or legs that won’t heal, and a change in the color of the legs. Risk factors include smoking, diabetes, obesity, high blood pressure, and high cholesterol.
Diagnosis of PAD involves a physical examination and tests such as the ankle-brachial index (ABI), which compares the blood pressure in the ankle with the blood pressure in the arm. Imaging tests like ultrasound, angiography, and magnetic resonance angiography (MRA) can also help visualize the arteries and assess the severity of the disease.
Limb Salvage
Limb Salvage involves a combination of techniques aimed at preventing amputation in patients with severe PAD. This approach focuses on restoring blood flow and promoting healing of ulcers or wounds. At VIR Chicago, our specialists use the latest methods to achieve successful limb salvage, improving patient outcomes and quality of life.
Angiography
Angiography is an imaging technique used to visualize the inside of blood vessels. This procedure involves injecting a contrast dye into the arteries and taking X-ray images. Angiography helps diagnose the extent and location of blockages, guiding further treatment. VIR Chicago utilizes state-of-the-art angiography to provide accurate diagnoses for PAD patients.
Balloon Angioplasty
Angioplasty is a minimally invasive procedure that involves inflating a small balloon inside a narrowed artery to widen it and restore blood flow. This technique is often combined with stenting to keep the artery open. At VIR Chicago, we perform angioplasty using advanced imaging to ensure precision and effectiveness. The basic balloon angioplasty procedure, used for peripheral artery disease treatment, can open blocked arteries by expanding the inner diameter with a balloon mounted on a thin tube. The catheter is inserted via a tiny nick in the skin, usually in the groin area (see photo).
A catheter enters the artery via a tiny skin nick. This is not painful.
Balloon Angioplasty Breakthrough
Now, we are among the first groups using new drug eluting balloons, that can deliver medicine directly into the wall of the artery, to prevent scar tissue formation that could cause it to re-narrow. This may make stenting unnecessary.
drug-coated balloon delivers medicine into artery wall.
Medicine penetrates into artery wall, and acts to inhibit scar formation, keeping artery open longer.
Deep Vein Arterialization
Deep Vein Arterialization is an innovative procedure used to treat critical limb ischemia in PAD patients. This technique involves redirecting blood flow from an artery to a vein, creating a new pathway for blood to reach the affected limb. VIR Chicago’s experts are at the forefront of this cutting-edge treatment, providing hope for patients with severe PAD.
Opening blocked arteries, without open surgery
Peripheral artery disease treatment often consists of non-surgical procedures for blocked arteries in the legs, which can be performed at one of our groups 5 hospital locations. Balloon angioplasty, laser guided artery re-opening (see below), atherectomy, stent placement, and thrombolysis are a few of the non-surgical procedures that are offered.
Peripheral Artery Disease (PAD) usually results from arteriosclerosis (hardening of the arteries associated with cholesterol deposits). Many causes have been identified including elevated cholesterol, smoking, diabetes, high blood pressure and congenital factors. The symptoms usually begin with pain in the calves or legs when walking, that is relieved by rest (this symptom is called “claudication”). Hip and thigh pain may be caused by PAD, as may erectile dysfunction.
Interventional radiologists can perform non-surgical procedures such as balloon angioplasty, laser guided drilling, atherectomy, stent placement and thrombolysis to open blocked arteries and restore circulation to the legs. We also supervise non-procedural clinical exercise programs, medical therapy and treatment of peripheral artery disease through our clinic.
Even some patients with severely low blood flow causing gangrene may have their toes, or limbs saved by interventional radiology (see photos or before and after intervention). Not every extremity can be saved, but new advances allow hope in some cases that formerly were hopeless!
All the physicians in our group, VIR, hold sub-specialty board certification to perform image guided endovascular repair of peripheral arteries. We have performed these procedures for over 30 years, on thousands of patients who are seeking peripheral artery disease treatment.
While Cardiologists are trained to do this procedure mainly in the heart, Interventional radiologists are specifically trained to do balloon angioplasty in vessels outside the heart. Studies from the interventional radiology literature show the procedure is effective in the larger arteries supplying the legs, kidneys, carotids, abdominal vessels, and in other parts of the body…
Laser-guided artery drill
Some patients have leg arteries that are totally obstructed, over a long distance. Many of these patients have gangrene, and need open surgery to prevent amputation. We have recently started using a revolutionary new device the Ocelot Catheter, a laser-guided drill to open a channel in a completely blocked artery (see video below). This is a breakthrough technology that uses no radiation or X-ray guidance, and has allowed our doctors to succeed where others have failed,restoring blood flow to dying legs without surgery. This drill “sees” its way down the blocked artery using a process called Optical Coherence Tomography. Our doctors are the first Interventional Radiologists in the country to use this device and have pioneered use of this device in the Chicago area. We are aggressively using the technology to help our patients with the worst peripheral arterial blockages.
The catheter, shown here, can drill through totally blocked arteries using high intensity laser light to guide itself without using X-radiation.
The catheter is shown here, steering through a chronically blocked artery, by sensing its location with laser-light. To see an animation of this device.
Stenting
Stenting involves placing a small wire mesh tube, or stent, into a narrowed or blocked artery to keep it open. This procedure helps maintain adequate blood flow and prevent re-narrowing. VIR Chicago’s specialists use the latest stenting technologies to provide long-lasting relief for PAD patients.
Stents are mesh-like metal tubes that can be expanded inside arteries to hold them open when balloon angioplasty alone isn’t successful (see photo). Our doctors placed the first available flexible metal stent into a human in Illinois in the 1980’s. Stent grafts (fabric covered stents) are used in peripheral arteries to cover long distances, or to seal over bleeding areas.
Stent grafts for leg arteries
Some patients will have scar tissue grow into stents, causing another blockage of flow. Stent grafts (or “covered stents”) have a fabric layer to protect from this process, to try and create a more durable blood flow. We have been placing these devices for many years.
A close-up view of a covered stent, or stent graft
Here, a non-surgically placed covered stent carries blood down the leg (white tubular structure)
Drug-Eluting (releasing) stents for leg arteries
The newest advance in stenting of leg arteries is drug eluting stents. Long available for use in the heart, these larger stents are coated with medicine that inhibits the ingrowth of scar tissue that can re-block the artery. We are one of the first sites in our region to use these new devices in leg arteries. Medicine released from a drug coated stent may inhibit scar tissue formation and keep the vessel open longer.
Atherectomy
Atherectomy is a procedure that removes plaque buildup from the arteries, improving blood flow. This technique uses a specialized catheter with a cutting device to shave away the plaque. At VIR Chicago, we offer atherectomy as an effective treatment option for patients with severe arterial blockages.
While balloon angioplasty can open arteries by pushing a blockage open, and stretching the diseased artery, atherectomy catheters actually can remove the hard deposits blocking flow. The technology behind these devices has improved over the years, and we use various kinds of these catheters to open arteries. A special atherectomy catheter can scrape out deposits blocking an artery to open it.
Thrombolysis
This alternate peripheral artery disease treatment involves injecting “clot-busting” drugs via a catheter directly into clots in leg arteries (or veins). The clots can be melted down to avoid surgery. We sometimes use mechanical thrombolysis, in which a tiny “blender-like” catheter-device sucks out clot from a blocked artery to open the vessel faster. A mechanical thrombectomy catheter creates a vortex, and sucks out clot from a blocked artery.
This device, the Indigo System, is used to power-suction clot from inside arteries and rapidly restore blood flow.
If you or a friend or loved one may have blocked leg arteries or symptoms suggesting it, ask your doctor. We specialize in using the newest technology to restore and keep blood flowing to the legs, and other areas. Our doctors have been opening arteries for 30 years, using pioneering minimally invasive techniques. We invite you to contact us for a consultation on peripheral artery disease treatment options or call us directly at (630) 856-7460.
