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Peripheral Vascular Disease (cont.)

Medical Treatment

Interventional procedures

Percutaneous (through the skin) balloon angioplasty, or just "angioplasty," is a technique for enlarging an artery that is blocked or narrowed without surgery.

A diagnostic angiogram is done first to locate the blockage or narrowing and determine the severity, because, for instance, minor blockages are treated medically.
A thin plastic tube called a catheter is inserted into the affected artery through a needle under local anesthesia. X-ray dye or contrast is injected, x-ray films are taken and studied by the doctor. If the obstruction is significant, especially in a larger more proximal artery, angioplasty may be reasonable. The angioplasty catheter has a tiny balloon attached to the end. The balloon is inflated, pushing aside the plaque and widening the artery so that it no longer restricts blood flow.
The balloon is then deflated and removed from the artery.

Angioplasty is not a permanent solution for most people. Stenting is a technique for arteries that are very severely blocked or begin to close up again after angioplasty.

Generally, after the stent is placed, angioplasty is carried out. Stenting and angioplasty are very useful if the obstructive lesions are localized and involve a small portion of the vessel. The majority of peripheral vascular lesions can be managed by placement of a stent, a small metal mesh sleeve that is fixed inside the narrowed artery.
The stent holds the artery open.
Eventually, new tissue grows over the stent. A bare metal stent was the initial approach. However, development of restenosis or fibrous scar tissue growth inside the stent leads to recurrent obstruction.
A new generation of drug-eluting stents is especially exciting, since a drug is attached to the metal sleeve that dissolves into the blood and prevents growth factors acting to develop scar tissue. The rate of restenosis has decreased.
Atherectomy is removal of an atherosclerotic plaque. A tiny cutting blade is inserted into the artery to cut the plaque away.