Peripheral Arterial Disease
Peripheral arterial disease is a complex circulatory disorder with an individual disease pattern. In early stages, non-invasive measures like lifestyle changes and medication may be sufficient to mitigate the symptoms and delay further narrowing of the arteries. In cases of advanced peripheral arterial disease, invasive methods are necessary to widen the affected vessels mechanically. Based on individual risk factors, symptoms, findings and the risk of relapse, a physician will recommend a tailor-made combination of the following treatment options:
- Lifestyle changes and medication
- Minimally invasive treatment
- Balloon angioplasty
- Open surgery
- Bypass surgery"
Lifestyle changes like quitting smoking, exercising on a regular basis and eating a healthier diet are essential to reduce symptoms, slow the progress of arteriosclerosis and prevent further damage. This also applies to patients undergoing minimally invasive procedures or surgery. It is also crucial to detect and treat diseases like diabetes and hypertension early on. Pharmaceutical treatment helps control risk factors like high blood sugar, hypertension and high cholesterol. If peripheral arterial disease has not progressed too far, a healthier lifestyle and pharmaceutical treatment may even help avoid surgery.
For many patients, minimally invasive treatment represents a very good alternative to open surgery. This minor type of intervention only requires local anesthesia. The physician executes the entire procedure through a thin, flexible tube – called a catheter – inside the vessel. Introducing the catheter into the vascular system only requires a tiny cut in the skin. As there is no need for general anesthesia and only a minor incision rather than a large surgical wound, minimally invasive treatment is lower risk for the patient. Patients are in better general condition and their wounds heal faster after minimally invasive interventions; they are therefore able to leave the hospital sooner than after open surgery. There are two primary minimally invasive treatment options: balloon angioplasty and stenting.
A physician inserts a tiny balloon via a catheter into the affected vessel at the narrowed area. There the balloon is inflated, carefully widening the affected area. The balloon is removed from the body after deflating. Blood now can flow unhindered through the dilated vessel. If necessary, a physician can also introduce a drug-coated balloon after the mechanical widening. By inflating the balloon for a certain time span, the medication on its surface releases into the irritated tissue in the artery and prevents a relapse of the narrowing (restenosis). After deflating, this balloon is also withdrawn.
Another way to prevent an affected blood vessel from re-narrowing is by stenting. A stent is a tiny mesh-like tube that can be implanted via a catheter. In order to implant the stent in the artery, it is crimped on a balloon. The stent is brought via the catheter up to the proper location in the artery. Then the balloon is inflated to adjust the stent to the arterial wall. After that, the balloon is deflated and removed, while the stent remains in the body to keep the vessel dilated.
The blocking material is cut out from inside the artery. A physician inserts a catheter into the vessel, introduces a tiny cutting instrument and removes the plaque.
In some severe cases of peripheral arterial disease, open surgery may be necessary. There are several methods. The most common are endarterectomy, atherectomy and bypass surgery.
A physician opens the affected artery with a small cut and removes any material blocking blood flow. Afterwards, a physician closes the incision via vascular suture.
The physician reroutes blood supply around the blocked area by connecting the artery ahead of the narrowed area with the healthy area after the narrowing with a healthy vessel section (graft) from another part of the body.