Minimally Invasive Vascular Treatments

Central arteries transport blood directly from the heart. Peripheral arteries carry blood everywhere else in the body (head, neck, arms, lower abdomen, legs, feet). Peripheral artery disease (PAD), also known as peripheral vascular disease (PVD), occurs when peripheral blood vessels are blocked, hardened and narrowed with plaque in a condition called atherosclerosis. This reduced or blocked blood supply increase a persons risk of having a heart attack or stroke and, when left untreated, can lead to amputations.

There are several treatment methods for peripheral artery disease (PAD), ranging from life changes (e.g. exercise and diet modifications, no smoking, control of blood sugar and blood pressure) and medications (such as blood thinners and cholesterol-lowering statins) to angioplasty and surgery.

What are the symptoms?

Signs that you may have peripheral vascular disease are:

• Leg pain that often occurs when exercising and ceases during rest (called claudication)
• Numbness, coldness, change of color or loss of hair in the legs or feet
• Muscle pain in the thighs or lower legs
• Paleness, blueness or weak or absent pulse in a limb
• Ulcers or sores on the legs or feet that don’t heal
• A change in the way you walk.

Angioplasty and Stenting Ultrasound

During an angioplasty, a small tube, called a catheter, with a balloon on the end is inserted into the blocked artery and gently expanded. This pushes open the blockage and restores blood flow. The catheter is then removed. A tiny metal cylinder called a stent may be put in place to ensure that the artery stays open.

Atherectomy

Atherectomy refers to a group of angioplasty procedures that remove plaque from the artery walls. Plaque may be “shaved off” and removed, or, less commonly, it may be vaporized using laser light.

Bypass Grafting

This procedure restores circulation by bypassing a blocked vessel – that is, re-routing blood around it. A healthy vein is taken from another part of the body and re-attached, or grafted, above and below the blocked section of the diseased artery.

Catheter angiography is a minimally invasive diagnostic procedure that can evaluate and treat conditions within the blood vessels by inserting a catheter into a targeted artery and delivering contrast material for clear imaging results. This procedure can effectively eliminate the need for surgery and provides the most accurate visualization of targeted blood vessels to ensure proper functioning or detect any problems in their early stages.

A catheter angiogram may be performed to evaluate blood vessels within certain areas of the body in order to:

• Detect atherosclerosis
• Provide image guidance for stent implantation
• Identify disease or other abnormalities in the aorta

During the catheter angiogram procedure, an IV line is inserted into the arm, into which a small dose of sedative may be administered to relieve anxiety and any pain associated with this procedure. The catheter is then inserted under local anesthesia into the groin or arm, depending on the location of the area to be examined. The doctor guides the catheter to the targeted area under imaging guidance and then injects a contrast dye into the area before a set of X-rays are taken. The catheter is then gently removed with no stitches needed to close the incision.

While this procedure is considered safe for most patients, there is a risk of certain complications, including excessive exposure to radiation, allergic reaction, skin damage, blood clots and more. Women who are pregnant or breastfeeding should consult with their doctor before undergoing this examination.

What is atherectomy?

As you age, plaque – a material made of cholesterol, calcium and fibrous tissue can build up along the walls of your arteries. As more plaque accumulates, your arteries narrow and stiffen. Eventually, enough plaque builds up to reduce blood flow or cause irregularities in the normally smooth inner walls of the arteries.

An atherectomy is a procedure in which your vascular surgeon inserts a specialized catheter into a blocked artery to remove a buildup of atherosclerotic plaque from within the vessel. The catheter contains a sharp rotating blade, grinding bit, or laser filament, as well as a collection system that permits your surgeon to remove the plaque from the wall of the vessel and collect or suction any resulting debris.

Atherectomy is typically used to treat blockages where angioplasty and stenting cannot be performed. This may be as a result of anatomical factors, the location of the blockage, the hardness of the plaque, or other factors. More commonly, atherectomy is used as a complement to angioplasty and stenting, removing significantly hardened blockages, and allowing for the insertion of a balloon and stent. A stent is a small metal device that helps to prevent a blockage from re-forming at the same location.

Who is a good candidate for atherectomy?

You are a good candidate for an atherectomy if you have severe narrowing of peripheral, cannot have a bypass surgery, or if the patient does not want major surgery.

View this video to learn how laser atherectomy works?

If an aneurysm is suspected, your doctor may perform an aortic ultrasound in order to confirm this diagnosis. Patients at risk for this condition, including smokers and those over the age of 60, should be screened regularly for an aortic aneurysm.

Ultrasound imaging can be very useful in assessing the condition of the aorta. The sound waves utilized in scanning the aorta can give very detailed information concerning the blood flow and quality of musculature surrounding this vital tissue. In fact, the speed at which the blood is flowing through the very beginning of the aorta can reveal the heart’s condition as well.

Angioplasty and vascular stenting are minimally invasive procedures performed to improve blood flow in the body’s arteries. In an angioplasty, the artery is inflated with a balloon that is delivered and removed by a thin tube called a catheter. Stenting, often performed at the same time, involves the implantation of a flexible wire mesh tube called a stent that holds the newly expanded artery open. These procedures are particularly beneficial for patients suffering from peripheral vascular disease, carotid or coronary artery disease, renal vascular hypertension and other disorders that block or narrow the blood vessels.

The renal arteries deliver blood to and from the kidneys and may be affected by high blood pressure or a blood clot in the area that can prevent proper blood flow and eventually affect kidney function. Stenting can be used to effectively restore blood flow through the affected artery. A balloon catheter is guided to the renal artery to gently expand it, while the metal stent is kept in place to maintain the expanded position.

Endovenous Laser Therapy, simply known as EVLT™, is a minimally invasive procedure used to treat unsightly varicose veins as an alternative to the painful, lengthy ligation and stripping procedure. EVLT is fast, safe, and effective and allows patients to proudly show off their beautiful legs again, as well as improve their overall quality of life. This simple procedure is performed in the doctor’s office and takes less than an hour.

Ligation and stripping was once considered the primary treatment for varicose veins, as it had been used as the only treatment available to effectively treat the condition for many years. Although effective, ligation and stripping was considered an invasive surgical procedure that was performed under general anesthesia and required up to two weeks of recovery time before patients could return to work. Many patients also experienced pain and discomfort during and after this procedure, as it involves grasping the damaged vein through several incisions and then removing it.

• Takes less than an hour to perform
• Performed as an outpatient procedure in the doctor’s office
• Offers immediate relief from symptoms
• No downtime
• No need for general anesthesia
• No scarring
• Up to a 98% success rate

Recovery and Results

After the EVLT procedure, most patients experience mild bruising and tightness in the legs, although these side effects usually subside within a few days. Patients can return home immediately and many are able to resume work and other normal activities the very same day. Exercise and heavy lifting should be avoided for some time.
The results from the EVLT procedure are visible immediately. Patients can enjoy beautiful, pain-free legs as they leave their doctor’s office. Up to 98% of patients are satisfied with the results of the ELVT procedure for up to 5 years after. These statistics are much higher than the satisfaction for alternative procedures, as EVLT is quickly on its way to becoming the new standard for treating varicose veins.

VNUS Closure® is a minimally invasive alternative to vein stripping for the treatment of varicose veins and its common underlying cause, venous reflux. Instead of surgically removing the diseased vein, the VNUS Closure procedure delivers radio frequency (RF) energy via a catheter to the clogged vein, which shrinks in the heat and eventually closes. Anesthetic and a saline solution are also injected to numb the leg, squeeze blood from the vein and protect surrounding tissue. Ultrasound imaging is used to locate the treatment site, guide the catheter and confirm that the vein has been fully closed.

After the procedure, blood is naturally re-routed through other, healthier veins in the body. VNUS Closure offers benefits over vein stripping and other treatment methods such as faster treatment and recovery time, less discomfort during and after the procedure, and little or no scarring, bruising or swelling. VNUS Closure can be performed under local or general anesthesia in as little as 45-60 minutes.