Protecting Limbs

With Peripheral Arterial Disease, Rapid Treatment Saves Limbs

Approximately 10 million Americans have peripheral arterial disease (PAD), says Nancy Harthun, M.D., an associate professor of vascular and endovascular surgery at the University of Virginia Health System. And severe cases of PAD are responsible for more than 120,000 leg amputations annually, according to the Society for Vascular Surgery.

For patients with advanced PAD, UVa offers leading-edge revascularization procedures to save limbs, state-of-the-art vascular imaging technology, and an experienced multidisciplinary team that includes vascular surgeons, interventional radiologists and radiologists.

The sooner, the better

Patients should be referred for PAD treatment as soon as possible, says Alan Matsumoto, M.D., an interventional radiologist and professor of radiology at UVa. Earlier referrals provide patients with more treatment options and better outcomes over a longer period of time, he says.

Patients at UVa are carefully assessed with leading-edge equipment to diagnose and plan PAD treatment. UVa's 3T MRI and dual source CT scanners provide sharper, more detailed images of a patient's blood vessels. "We can get an overall map of the patient's arterial and venous map to better plan for a patient's treatment," Matsumoto says. "And we have experts in performing and interpreting these noninvasive procedures."

Once the patient's condition is diagnosed, UVa offers the full range of treatment, including traditional stenting and angioplasty procedures, synthetic and venous bypass grafts and mechanical thrombectomy devices and medicines to help break down blockages. The procedure chosen is based on the patient's clinical situation and anatomy.

 

Treatment approaches at UVa include:

Subintimal Angioplasty

  • UVa has been a regional pioneer in using this procedure, originally developed in Great Britain.
  • The procedure uses a wire inserted into an arterial wall instead of the lumen. Once the wire passes the blockage, it is advanced back into the vessel lumen and a balloon is used to open the passageway.
  • Proven effective for treating long obstructions exceeding 10 cm in the femoral or tibial arteries.

"We've been able to salvage many limbs and prevent the need for an amputation with subintimal angioplasty," says interventional radiologist J. Fritz Angle, M.D., associate professor and Chief of Interventional Radiology at UVa. "It has good long-term patency."

Minimally Invasive Bypass Grafts

  • UVa has also been a national leader in using endoscopic vein harvesting for bypass grafts to treat PAD.
  • Using an incision no larger than 2 cm, the patency of this minimally invasive procedure equals traditional vein harvesting procedures.

UVa has adopted a procedure traditionally used in heart-bypass procedures to treat PAD, highlighting UVa's multidisciplinary approach in finding new and effective treatment. "We're taking a cardiac surgical technique and applying it to a vascular procedure with good results," Harthun says.

Clinical Trials

  • Crosser device - The device is useful in treating calcified blockages in arteries that don't respond to traditional angioplasty. The device attaches a wire to an ultrasound machine that delivers high-frequency waves to help the wire pass through the obstruction more easily, Angle says.
  • Expert Trial - The trial is examining the usage of stents to treat blockages in small tibial vessels below the knee, where stents traditionally aren't used.

 

To refer a patient for PAD treatment, call UVa Physician Direct at 800-552-3723.