Angioplasty
Occlusion in Critical Lower Limb Ischemia TASC D. Vascular Disease
Management. 2011 Nov; 8:E187–E197
This is the gold standard and first-line treatment for
patients requiring intervention. This ‘keyhole
technique’ involves
insertion of a catheter
with a small balloon on
the tip into the artery to
widen the passageway.
Sometimes a stent
(small metal frame)
maybe placed inside the
artery to hold the walls
open. The surgeon
guides the balloon by watching an image of your
artery on a video monitor.
If there are no complications it may be possible to
go home on the same day!
Sultan S, Hynes N. Mid-Term Results of Subintimal Angioplasty for Critical
Limb Ischemia: 5-Year Outcomes. Vascular Disease Management. 2011
Sept;8:E155–E163
Bypass Surgery
If your symptoms are getting worse and the
blockage cannot be treated with angioplasty then
open bypass surgery may be
needed. This surgery, which
requires a hospital stay, can
treat blocked arteries in the
abdomen or the leg. The
surgeon uses a graft, either a
vein from your own leg or a
synthetic (man-made) tube, to
create a path around the
artery blockage.
Sultan S, Hynes N. Five-Year Irish Trial of CLI Patients With TASC II Type
C/D Lesions Undergoing Subintimal Angioplasty or Bypass Surgery Based on
Plaque Echolucency. J Endovasc Ther 2009 Jun;16(3):270-283. PMID:
19642779
Sultan S Non-operative active management of critical limb ischaemia:initial
experience using a sequential compression biomechanical device for limb
salvage. Vascular 2008 16(3):130-9
Sultan et al. A prospective feasibility study of duplex ultrasound arterial
mapping, digital subtraction angiography and magnetic resonance
angiography in the management of critical limb ischaemia by endovascular
revascularisation Ann Vasc Surg 2007 21(4)
Scheinert D, Peeters P, Bosiers M, O'Sullivan G, Sultan S, Gershony G.
Results of the multicenter first-in-man study of a novel scoring balloon
catheter for the treatment of infra-popliteal peripheral arterial disease.
Catheter Cardiovasc Interv. 2007 Dec 1;70(7):1034-9. PMID: 18044759
Sultan S, Hynes N. Recent trends in the management of peripheral vascular
disease in high risk patients. Heart Wise. 2007: 10(2);21-25.
Hynes N, Sultan S. Reinforced long saphenous vein bypass graft for
infrainguinal reconstruction procedures: case series and literature review.
Vascular. 2006 Mar-Apr;14(2):113-8. PMID: 16956481
O'Sullivan CJ, Hynes N, Sultan S. Haemoglobin A1C (HbA1C) in Nondiabetic and Diabetic Vascular Patients. Is HbA1C an Independent Risk
Factor and Predictor of Adverse Outcome? Eur J Vasc Endovasc Surg. 2006
Aug;32(2):188-97.;PMID: 16580235
Hynes N, Sultan S. The influence of subintimal angioplasty on level of
amputation and limb salvage rates in lower limb critical ischaemia: a 15-year
experience. Eur J Vasc Endovasc Surg. 2005 Sep;30(3):291-9. PMID:
15939635
Hynes N, Sultan S. Subintimal angioplasty as a primary modality in the
management of critical limb ischemia: comparison to bypass grafting for
aortoiliac and femoropopliteal occlusive disease. J Endovasc Ther 2004
Aug;11(4):460-71. PMID: 15298498
Protection of your Graft.
If you have an open or
endovascular graft in place, inform the relevant
doctor if you are having further surgery or any
invasive procedure, such as an angiogram. You may
need ‘prophylactic’ antibiotics to protect your graft
from infection.
References
Sultan S, Hynes N. Cardiovascular disease: primary prevention, disease
modulation and regenerative therapy. Vascular. 2012 Oct;20(5):243-50.
PMID:23019607
Sultan S, Tawfick W, Hynes N. Cool Excimer Laser-Assisted Angioplasty vs
Tibial Balloon Angioplasty in Management of Infragenicular Tibial Arterial
Prof Sherif Sultan, MB BCh MCh MD FRCSI
DEVS FISVS FASA DMD FRCS EBQS-VASC
FACS, PhD
Depart of Vascular & Endovascular Surgery
Galway Clinic, Doughiska, Galway
Phone: +353 91 720122
Fax: 353 91 720121
E-mail: [email protected]
www.vascular.ie
Peripheral Arterial
Disease
A Guide for Patients
» Family history of vascular problems
receiving the care that is most appropriate to your
condition.
Reducing Risk Factors
Medical treatment
What is peripheral arterial disease?
Your arteries deliver oxygen-rich blood from your
heart to other parts of your body. Your peripheral
arteries carry blood away from the heart to your
arms and legs. The peripheral arteries in your legs
are extensions of the largest artery in your body, the
aorta. The aorta travels down through your
abdominal region and branches off into the iliac
arteries of each leg. The iliac arteries further divide
into smaller arteries and deliver blood down your
legs to your toes.
Healthy peripheral arteries are smooth and
unobstructed, allowing blood to flow freely to the
legs and provide oxygen, glucose, and other
nutrients that your legs need. Typically with age,
the peripheral arteries build up plaque, a sticky
substance made up mostly of fat and cholesterol.
Plaque narrows the passageway within the arteries
and causes them to become stiff. Peripheral arterial
disease results when the peripheral arteries become
too narrow or obstructed and limit the blood flow to
the legs. If left untreated, peripheral arterial disease
can cause pain or aching in the legs, difficulty with
walking, resting pain in the foot at night in bed,
non-healing sores or infections in the toes or feet,
and can lead to limb loss in its most severe form. In
addition, it can be associated with other serious
arterial conditions leading to heart attacks and
stroke.
Causes and Risk factors
» Age
» Gender—males are more prone to the
»
»
»
»
»
»
condition than females
Hypertension (high blood pressure)
Diabetes
Smoking
High cholesterol
Obesity
Lack of exercise
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Stop Smoking
Low Fat Diet
Control High Blood Pressure
Care for your Feet
Exercise Daily
All patients with peripheral vascular disease require a
combination of medications. These thin the blood, reduce
the build-up of plaque lower blood pressure and therefore
promote optimal blood flow. Patients with mild disease,
called claudication, can be treated with medication,
reduction of risk factors and exercise alone.
Symptoms
ArtAssist Device
There may be no symptoms in the early stages of
peripheral arterial disease. Developing symptoms
may include discomfort or pain in your legs when
walking but no pain when you rest.
The Art Assist device is an ‘external pneumatic
compression device’, i.e. a device that massages your foot,
ankle and calf to improve your circulation. It has been
shown to triple blood
flow, and in so doing,
dramatically increases
pain-free
walking
distance, heals diabetic
and non-diabetic arterial
ulcers, and saves limbs
in cases unsuitable for
endovascular therapy or
surgery.2 This is a
mobile device that you can use in the comfort of your own
home.
Diagnosis
Diagnosis of vascular disease begins with a careful
medical history, including risk factors and physical
exam, followed by non invasive tesing.
Non-Invasive Testing: Non-invasive testing uses
state of the art ultrasound technology to evaluate
flow, perfusion and pressures within the vessels at
rest and with exercise. These procedures are
painless (no needles are involved) and can help to
determine if blood vessel disease is present, the
location, and severity. Exclusively from the results
of these tests, the surgeon will determine the need
for more invasive testing or procedures to treat
vascular disease.1
Treatment
Vascular surgeons
are the only
physicians who can
perform all the
treatment options
available, including medical management,
minimally invasive endovascular angioplasty and
stent procedures, and open bypass surgery. Only
when you see a vascular surgeon who offers all
treatment modalities will you be assured of