Paoli, Pa. (October 2005) — Interventional radiology, a growing subspecialty of radiology, is offering patients such as Vice President Dick Cheney nonsurgical treatments for vascular conditions that are safe, minimally invasive and easily tolerated.
Cheney recently became the latest high-profile individual to benefit from interventional radiology when doctors placed endograft stents in arteries behind his knees to repair aneurysms, rather than perform traditional surgery to bypass the arterial bulge.
"Only a few years ago, conditions such as the vice president's would have required surgery, which carries danger for patients with high-risk who have a history of cardiovascular disease, like Mr. Cheney," said Atul Gupta, M.D., interventional radiologist at Paoli Hospital.
"With advances in interventional radiology, we can treat a variety of vascular problems—aneurysms, peripheral vascular disease, and blocked arteries—with minimally invasive, image-guided procedures that offer better options for the management of vascular disease," said Gupta.
In recent years, former presidential contender Bob Dole and the late comedian Rodney Dangerfield selected an interventional radiology procedure for treatment of their abdominal aneurysms, which can be life-threatening if they rupture.
The public is most aware of interventional radiology's use in cardiology to open blocked arteries via balloon angioplasty. Advances in imaging technology, which produce superior detailed images of blood vessels, have expanded the capabilities of interventional radiology.
Today, interventional radiologists are treating a variety of conditions ranging from shrinking uterine fibroids to delivering cancer drugs to tumors by threading tiny tubes, wires, balloons, coils and bits of plastic into blood vessels to deliver therapy right where it's needed.
In the vascular field, Gupta sees particular potential in the application of interventional radiology techniques to the treatment of peripheral vascular disease (PVD)—blockages of arteries in the legs, arms, kidneys and neck that can lead to serious problems, including gangrene, amputation, high blood pressure and stroke.
Overall, PVD affects 8 to 10 million Americans, including one-fifth of individuals older than 65, and yet it is extremely underdiagnosed, Gupta said. "Studies show PVD is quite common, but is diagnosed in less than 25 percent of individuals who have it," he said.
A National Heart, Lung, and Blood Institute conference in 2003 identified PVD as a condition whose prevalence and societal impact will increase in the next two decades, associated with an upswing in health risks and avoidable consequences—even though the knowledge exists to permit prevention, early diagnosis, treatment and rehabilitation.
PVD commonly manifests itself as leg pain when walking, known as claudication. When the arteries in the leg become blocked with plaque, exercise causes cramping because the legs are not getting enough blood to handle the increased demand, Gupta said. The pain goes away when the individual stops walking.
"This is the most typical symptom of PVD and should not be ignored," Gupta said. "Some people think leg pain is a normal part of aging, but it is not. It is really an early sign of a circulation problem. It's also important to remember that because PVD is caused by atherosclerosis, people who have it are at high risk of blocked arteries in other areas of their bodies, in particular the heart and brain."
Treatment of PVD typically begins with the least invasive options: lifestyle changes, including smoking cessation, exercise, and a low-fat diet, and perhaps cholesterol-lowering medication. But Gupta notes that by the time a patient has symptoms, the condition usually has progressed to where intervention is necessary.
"Most patients will need angioplasty of the affected leg arteries," Gupta said. "Occasionally, angioplasty is not enough and we have to hold open the artery with a stent."
Gupta said Cheney received an endograft, a stent covered with a special material that redirects the blood flow around an aneurysm, causing the bulge to shrink and clot around the stent. Interventional radiologists guided the stent through a catheter into Cheney's damaged blood vessels to create the new channel. The procedure is minimally invasive, accomplished with a nick in the skin as small as a pencil point, and is performed under local anesthesia.
'The advantage of the treatment is that it is performed while the patient is conscious, which is less risky for patients in the high-risk group, there is less pain than a recovery from a surgical bypass, and patients go home quicker," Gupta said.
The fact that the interventional radiology team took care of both of Cheney's knee aneurysms, when they originally had planned to do one knee at a time, shows how well the procedure is tolerated, according to Gupta.
Gupta urges patients to be aware of their risks for PVD, including smoking, high cholesterol, high blood pressure and diabetes. He said there's a very quick, painless test that doctors can perform—the ABI test, or ankle-brachial index. "Basically, you measure the blood pressure in the arm and in the leg and check the ratio of the two," Gupta said. "The pressure should be the same. If the pressure in the leg is reduced, that's a warning there is a narrowing of the arteries and further testing is needed."
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