Peripheral Vascular Disease Treatment (PVD)

Peripheral Vascular Disease results from fatty deposits (plaque) that build up in the arteries outside the heart (peripheral arteries); mainly the arteries supplying the legs and feet. This buildup narrows or blocks your arteries and reduces the amount of blood and oxygen delivered to your leg muscles and feet. The iliac, femoral, popliteal and tibial arteries are commonly affected.

What are Peripheral Vascular Disease symptoms?

The pain of PVD usually goes away when you stop exercising, although this may take a few minutes. When muscles are being used, they need more blood flow. That means if there’s a blockage due to plaque buildup, the muscles won’t get enough blood during exercise to meet their needs. That’s what causes the pain, which is called “intermittent claudication”. The term comes from the Latin word meaning “to limp.”

How is PVD treated?

For a minority of patients minimally invasive treatment or surgery may be needed. Minimally invasive procedures consist of angioplasty or stent placement (as is done in the heart for CAD) or clot-removal treatment. They are nonsurgical and are performed by making a small incision through which a catheter is inserted to reach the blocked artery. A tiny balloon is inflated inside the artery to open the clog.  A stent — a tiny wire mesh cylinder — may also be implanted at this time to help hold the artery open. Sometimes a medicine can be given through the catheter or a special device can be inserted through it to remove a clot that's blocking the artery.

Thrombolytic Therapy

Clots may form in arteries or veins. In general, clotted arteries will cause severe pain without swelling whereas clotted veins cause dull aching pain with swelling.

Blood clots can be harmful if they obstruct blood flow to a limb or an organ, thus starving the area and causing damage to the tissue. A stationary blood clot is called a thrombus.

Clots most commonly form in blood vessels which are injured, or have reduced rate of blood flow for example, in patients with Peripheral Vascular Disease (PVD). Rarely, they may also be associated with exposure to foreign bodies such as catheters, pacemaker wires, stents, or grafts.

Thrombolysis means breaking up or dissolving blood clots. This can be accomplished by using powerful blood clot dissolving drugs such as TPA (tissue plasminogen activator,) and/or mechanical devices to remove or break up the clot. The following will discuss the use of TPA specifically.

Certain patients may not be candidates for thrombolytic therapy, based on medical history, location of the clot, and any other medical issues that you may be currently dealing with. Appropriate use of thrombolytics will be determined by your doctor.  

Angioplasty and stent placement

An angioplasty and stenting procedure may also be performed to clear blocked arteries during an angiogram, depending on the location and extent of the blockage. An angiogram can also help physicians plan operations to treat more extensive problems.

An angioplasty uses a small balloon that is gently inflated inside of the artery to open up a narrowed section of the vessel. It is then deflated and removed.

In some instances a stent, or small metal mesh tube, may be deployed within the blood vessel. This will stay in place and serves to keep the blood vessel open, thus allowing blood to flow freely through it.

What happens during the procedure?

Conscious sedation is provided just prior to starting the procedure. You will lie flat on the x-ray table and be connected to several types of monitoring equipment. The technologist will prepare the skin over your groin by cleaning it with an antiseptic solution and placing sterile drapes and towels over you to create a sterile work space.  Local anesthesia (lidocaine) is injected into the skin overlying the common femoral artery in the groin. The Interventional Radiologist accesses the femoral artery and injects dye to allow them to see the arteries that supply the area of interest. The dye causes a brief, mild warm feeling as it enters your bloodstream. During the test, the Interventional Radiologist may ask you to hold your breath for about 5 to 15 seconds. In addition, he may ask you to lie perfectly still to prevent sudden movements from blurring the x ray pictures.

When the Interventional Radiologist finds the problem, he may be able to treat it with clot busting medicine, balloon inflation (angioplasty) or stent placement.

When the procedure is completed the catheter is removed and pressure is applied over the artery until there is no bleeding (approximately 15min). This procedure typically requires 1 - 3 hours.

What happens after the procedure?

Since conscious sedation medicine was administered and the femoral artery was punctured, you will be required to stay to recover for 4-6 hours after the end of the procedure. While in recovery, you are monitored closely for signs of bleeding from the artery in the groin and ensure that the effects of the sedation have worn off. Patients must have a responsible adult available to drive/escort you home from the hospital.

Since the artery is a high pressure system, patients should refrain from lifting more than 10 lbs, refrain from strenuous activity or anything which causes abdominal distension for the following 48-72 hours. Any straining such as vomiting, coughing, forced bowel movements could dislodge the clot that forms to seal the artery and cause bleeding. If you note any signs of bleeding, such as bulging under the skin the size of a golf ball, put direct pressure to the area, call your doctor, and go to the nearest emergency room or call 911 for assistance.

Do not take a tub bath, go in a hot tub or submerge in water for 5 days. Leave the sterile dressing on for 24 hours, then shower and clean the area daily.  Place a clean Band-Aid over the site each day for 5 days. Report any signs of infection (redness, swelling, discharge and fever) to your doctor.

At home, you can eat normally, but you should continue drinking extra fluids for 1 to 2 days after your procedure.

 

If you have any questions or need to reschedule an appointment please feel free to contact the Interventional Radiology Office at 802- 847-8359. Our business hours are Monday – Friday 8:30 a.m. to 5 p.m. Someone is available to take your call after hours for emergencies.

This information is provided by the Fletcher Allen Health Care, Department of Radiology, Division of Interventional Radiology and is not intended to replace the medical advice of your doctor or health care provider. Please consult your health care provider for advice about a specific medical condition. For additional health information, please contact your health care provider.