Peripheral vascular disease (PVD), also known as peripheral arterial disease (PAD), develops most commonly as a result of atherosclerosis, or "hardening of the arteries." This occurs when cholesterol and scar tissue build up, forming a substance called plaque inside the arteries, which become narrowed and clogged. The clogged arteries cause decreased blood flow to the legs, which can result in pain when walking and, in some cases, gangrene and amputation. People with PVD are at increased risk for heart disease, aortic aneurysms and stroke. PVD is also a marker for diabetes, hypertension and other conditions.
Major surgery is sometimes required to remove blockages from arteries or to bypass the clogged area. In many cases, however, the interventional radiologists of Bryn Mawr Hospital can open blocked or narrowed blood vessels without major surgery using nonsurgical techniques.
Symptoms of PVD
The most common symptom of PVD is claudication, which is leg pain that occurs when walking or exercising and disappears when the person stops the activity. Other symptoms include: numbness and tingling in the lower legs and feet, coldness in the lower legs or feet and ulcers or sores on the legs or feet that don't heal.
The most common test for PVD is the ankle-brachial index (ABI), a painless exam in which a special stethoscope is used to compare the blood pressure in the patient's ankles and arms. Based on the results of the ABI, as well as the individual's symptoms and risk factors for PVD, a physician can decide if further tests are needed. When the ABI indicates that an individual may have PVD, other imaging techniques may be used to confirm the diagnosis, including duplex ultrasound, magnetic resonance angiography (MRA) and computed tomography (CT) angiography.
The risk factors associated with PVD include:
High blood pressure (hypertension)
Family history of heart or vascular disease
Lack of exercise or physical activity
Age over 50
Interventional Radiology Treatments
In some cases, lifestyle changes—such as smoking cessation, a structured exercise program and a low-fat diet—can stop the progress of PVD and manage the disease. Sometimes medications, including those that lower cholesterol or control high blood pressure, are prescribed to treat PVD. For other individuals, procedures that open up clogged blood vessels are necessary to treat PVD.
Major surgery is sometimes required to remove blockages from arteries or to bypass the clogged area. These procedures are performed by vascular surgeons. In many cases, however, interventional radiologists can open blocked or narrowed blood vessels caused by PVD and other conditions without major surgery using one of the following interventional radiology techniques:
In this technique, the interventional radiologist inserts a very small balloon attached to a thin catheter into a blood vessel through a small nick in the skin. The catheter is threaded under X-ray guidance to the site of the blocked artery. The balloon is then inflated to open the artery.
With this procedure, the interventional radiologist inserts a small metal tube called a stent to hold the blood vessel open.
If the blocked artery is caused by a blood clot, the interventional radiologist inserts thrombolytic (clot dissolving) drugs through a catheter to eliminate the clot and restore blood flow.
Benefits of Interventional Radiology
In most cases, these minimally invasive procedures do not require hospitalization or general anesthesia. There is no surgical incision—just a small nick in the skin—and no stitches are needed. Patients may return to normal activity shortly after the procedure.
For more information or to schedule an appointment with a Bryn Mawr Hospital interventional radiologist, call 484-337-4115.
Bryn Mawr Hospital
New Appointments 1.866.CALL.MLH or 484-580-1000
Bryn Mawr Hospital
130 South Bryn Mawr Avenue
Bryn Mawr, PA 19010
For more information, call 1.866.CALL.MLH.