Vascular Disease

Peripheral Arterial Disease (PAD)

Peripheral Arterial Disease (PAD) is a narrowing of the peripheral arteries caused by atherosclerosis (hardening of the arteries). It most commonly affects the arteries of the pelvis and legs, (including femoral artery and the popliteal artery).

More than 12 million people in the U.S. and more than 30 million worldwide are affected by PAD. Patients are five times more at risk for limb amputation if they are left untreated. As people age, the risk of developing leg artery disease increases. People older than 50 have increased risk of developing the disease and by age 65 approximately 12-20% of the U.S. population will have PAD. Other factors increasing the chances of developing PAD include:

  • Diabetes
  • Genetics
  • High blood pressure
  • High cholesterol
  • Poor Diet
  • Sedentary Life Style
  • Smoking

- Information found on http://www.heart.org

An illustration of an artery from a PAD patient, partially blocked by atherosclerosis.

An illustration of an artery from a PAD patient, partially blocked by atherosclerosis.

Interventional Treatment Options for PAD

In severe cases of PAD, lifestyle changes and medication may not be enough to improve symptoms. If the disease has advanced, recommendations may be for surgical or minimally invasive treatments. The choice of treatment depends on the pattern and extent of blockages, as well as other factors such as general health and the presence of other medical conditions. Sometimes a combination of various procedures available may be required for the most favorable result.

Traditional treatment such as surgical bypass is effective, but invasive. Despite the recent availability of multiple new endovascular technologies for the treatment of PAD, angioplasty balloons have remained the most frequently used modality either as primary therapy or adjunctive therapy along with stents and other devices. This is due to their simplicity of use, safety, relatively low cost and the paucity of data in most subsets demonstrating any significant advantages.

Conventional balloons have certain limitations in the treatment of complex PAD affecting the femoral and popliteal segments. These include a high rate of uncontrolled dissections that may require bailout stenting, inadequate luminal expansion and a low primary patency rate requiring repeat revascularization. Specialty scoring and cutting balloons have been developed to help address some of the inadequacies associated with conventional balloon angioplasty.

Interventional Treatment Options for PAD

In severe cases of PAD, lifestyle changes and medication may not be enough to improve symptoms. If the disease has advanced, recommendations may be for surgical or minimally invasive treatments. The choice of treatment depends on the pattern and extent of blockages, as well as other factors such as general health and the presence of other medical conditions. Sometimes a combination of various procedures available may be required for the most favorable result.

Traditional treatment such as surgical bypass is effective, but invasive. Despite the recent availability of multiple new endovascular technologies for the treatment of PAD, angioplasty balloons have remained the most frequently used modality either as primary therapy or adjunctive therapy along with stents and other devices. This is due to their simplicity of use, safety, relatively low cost and the paucity of data in most subsets demonstrating any significant advantages.

Conventional balloons have certain limitations in the treatment of complex PAD affecting the femoral and popliteal segments. These include a high rate of uncontrolled dissections that may require bailout stenting, inadequate luminal expansion and a low primary patency rate requiring repeat revascularization. Specialty scoring and cutting balloons have been developed to help address some of the inadequacies associated with conventional balloon angioplasty.

12 Million

Affected by PAD in U.S.

30 Million

Affected by PAD worldwide

12 - 20%

Will have PAD by age 65

End Stage Renal Disease

There are five stages of renal or kidney disease and the fifth stage is called end stage renal disease (ESRD). The kidneys of patients with ESRD have lost most of their ability to remove waste and water from the body and require dialysis or a kidney transplant.

There are two types of dialysis; Peritoneal dialysis and hemodialysis.

Peritoneal Dialysis

About 200,000 ESRD patients use peritoneal dialysis.1 It is a procedure where the blood is filtered inside the body through the lining of the abdomen, using a fluid called dialysate inserted through a catheter.

Hemodialysis

Over 2 Million patients globally use hemodialysis to treat ESRD.1 Hemodialysis procedure where the blood is filtered, outside of the body, through a hemodialysis machine and then returns the blood to the body. The hemodialysis machine removes the waste and water from the body, when the kidneys are unable to function properly.

References:

  1. U.S. Renal Data System, USRDS 2013 Annual Data Report: Atlas of End-Stage Renal Disease in the United States, National Institutes of Health, National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, MD, 2014.
An angiogram of a patient with ESRD with a severely occluded arteriovenous fistula.

An angiogram of a patient with ESRD with a severely occluded arteriovenous fistula.

Arterial Fistulas and Grafts

Hemodialysis often requires surgically created pathways that connect a vein and artery, called arteriovenous fistulas (AV fistula) and arteriovenous grafts (AV grafts), to access the vascular system. Over time, the requirement for access can become more frequent, decreasing the intervals between hemodialysis interventions. Due to repeated access, the AV fistula or AV graft might become damaged and a surgical revision or surgery might be performed. Additionally, blockages or narrowing of the blood vessels can occur, requiring a procedure using a balloon catheter to clear the diseased vessels.

Image obtained from https://en.wikipedia.org/wiki/Arteriovenous_fistula

Blausen.com staff (2014). "Medical gallery of Blausen Medical 2014". WikiJournal of Medicine 1 (2).

Arterial Fistulas and Grafts

Hemodialysis often requires surgically created pathways that connect a vein and artery, called arteriovenous fistulas (AV fistula) and arteriovenous grafts (AV grafts), to access the vascular system. Over time, the requirement for access can become more frequent, decreasing the intervals between hemodialysis interventions. Due to repeated access, the AV fistula or AV graft might become damaged and a surgical revision or surgery might be performed. Additionally, blockages or narrowing of the blood vessels can occur, requiring a procedure using a balloon catheter to clear the diseased vessels.

Image obtained from https://en.wikipedia.org/wiki/Arteriovenous_fistula

Blausen.com staff (2014). "Medical gallery of Blausen Medical 2014". WikiJournal of Medicine 1 (2).

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