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Peripheral Vascular
Disease
Approximately 10% of the U.S. population
greater than 70 years old suffers from peripheral vascular disease caused by
atherosclerotic occlusions. Several hundred thousand radiological
interventional and surgical procedures are performed each year for the
treatment of vascular disease. The risk factors associated with
atherosclerosis include: hypertension, diabetes, tobacco abuse, obesity,
sedentary life style, hyperlipidemia, and
familial history.
It is estimated that there are 5000 cases of undiagnosed vascular disease in
Spartanburg and Cherokee counties alone. Signs and symptoms may include leg
pain or cramping when walking that is relieved by rest, leg or foot cramps
at night, diminished hair patterns of the legs, diminished pulses in the
groin or feet or ulcers of the lower extremities that are difficult to heal.
With the advent of new technology, the diagnosis of peripheral vascular
disease can often be confirmed with non-invasive, painless imaging
modalities such as magnetic resonance angiography. MRA avoids the potential
complications of arterial puncture and eliminates the risk of
contrast-induced renal failure. It can accurately identify patent distal
vessels in patients with severe peripheral vascular disease as well as
inflow stenoses and graft patency. Multiple studies now indicate that MRA is
a cost-effective outpatient imaging technique that in many cases is
sufficient for planning surgical bypass procedures or radiological
interventional procedures such as angioplasty.
Treatment options for peripheral vascular disease depend upon a number of
factors including co-morbidities and severity of disease. They may include
initiation of a structured exercise program, medical therapy, intra-vascular
intervention or surgical re-vascularization. Surgery may be avoided as many
arterial occlusions can be successfully treated with balloon angioplasty
and/or vascular stenting.
Percutaneous transluminal angioplasty (PTA) improves blood flow by creating
a controlled injury to the vessel wall. A balloon catheter is advanced over
a guidewire into the stenotic lesion and is dilated to increase diameter of
the vessel lumen. PTA has a high technical success rate with approximately
90% of patients experiencing improvement of
symptoms. Angioplasty may be performed alone or performed in conjunction
with vascular stent placement.
In the event of arterial occlusion, thrombolytic therapy may be instituted.
This is reserved for acute to sub-acute occlusions as chronic arterial
occlusions are usually treated surgically.