Peripheral Artery Disease

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.

Balloon Angioplasty

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.

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…

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.

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

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

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.