What is peripheral arterial disease?
An artery carries blood away from the heart, while a vein carries blood to it (except the pulmonary artery which carries blood to the lungs from the heart). Conditions like diabetes mellitus, hypertension, and high cholesterol, especially when controlled poorly, and cigarette smoking damage arteries over time. In time, the damage goes from bulges in arterial walls to complete occlusion that completely obstructs flow.
You may be unaware of these events until an artery loses more than 50% of its lumen, when you begin to cramp in your buttocks, thighs, or legs when you walk and later pain in the legs and feet at rest. Men may develop erectile dysfunction. As time goes on, some people will notice changes in the color of the skin of their legs and feet and some may experience odd sensations, too. Ultimately, if nothing is done, the skin breaks down, wounds refuse to heal or heal slowly, and in extreme cases, gangrene sets in and the patient loses the limb. This spectrum of abnormalities constitutes peripheral arterial disease to distinguish it from a similar condition that occurs in arteries that feed the brain and the heart and can affect, not only the limbs, but also the following vessels:
1. The carotid and vertebral arteries which supply the brain.
2. The renal arteries which supply the kidneys.
3. The mesenteric arteries which supply the bowels and the stomach.
What is peripheral arterial revascularization?
Arterial revascularization is the reopening of occluded arteries or widening of narrowed ones. It is different from surgical arterial bypass in which an artificial conduit or a native vein is connected to normal segments of the artery above and below the diseased segment. In revascularization a vascular specialist (an interventional radiologist, a vascular surgeon, or a cardiologist) uses various techniques, singly or in combination, to reopen blocked or narrowed native arteries. It may be by balloon angioplasty, cryoplasty, atherectomy, or stenting. When any of these is applied to a peripheral artery the procedure is known as peripheral arterial revascularization.
How is peripheral arterial revascularization performed?
First, you or a designee must ask of and receive from your care provider the merits and demerits of this procedure and its alternatives. When you have done this you must endorse the procedure by signing a document called a consent form. You will take nothing by mouth starting about 12 midnight of the day of your procedure. This allows the safe use of conscious sedation for your procedure. You will be required to take Aspirin and Plavix either before or at the start of the procedure to minimize clot formation in the artery during or shortly after the revascularization. In addition, you will receive large amount of intravenous heparin to complement the effects of Plavix and Aspirin You will be brought to the interventional radiology suit on the morning of the procedure and be placed on the procedure table and receive conscious sedation. The approach to the diseased vessel depends on what vessel is diseased, but in a majority of people one of the common femoral arteries is punctured. A local anesthetic will be applied at the skin entry site into the artery before puncturing it through a small skin cut. The operator will pass wires, catheters, sheaths, balloons, atherectomy device or a stent into the artery to reopen it. You may stay overnight in the hospital and will take daily Aspirin for life and daily Plavix for 3 to 6 months.
What are the contraindications to peripheral arterial revascularization?
Contraindications are conditions that make a procedure risky. You must ask your healthcare provider what the contraindications of peripheral arterial revascularization are. They include:
• Uncorrectable coagulopathy which is the ‘thinning’ of blood that may make you bleed much.
• Allergy to intravenous contrast agent.
• Poor kidney function which increases the risk of kidney failure after exposure to contrast agent.