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.