Arterial Intervention

Angioplasty/Stenting

Angioplasty uses imaging guidance to insert a balloon tipped catheter into a narrow or blocked blood vessel where the balloon is inflated to open the vessel and improve blood flow. This may be done in conjunction with vascular stenting – the placement of a small wire mesh tube within the blood vessel to help keep it open. The procedure is much less invasive than other surgical interventions and usually does not require general anesthesia.

Interventional Radiologists pioneered angioplasty and stenting, which was first performed to treat peripheral arterial disease. Balloon angioplasty and stenting has generally replaced invasive surgery as the first line treatment for PAD (peripheral artery disease). This is a minimally invasive treatment that does not require surgery, just a nick in the skin the size of a pencil tip.

Peripheral Arterial Disease (PAD) 

Peripheral arterial disease (PAD) is a disease in which plaque builds up in the arteries that carry blood to your head, organs, and limbs. When plaque builds up in the body's arteries, the condition is called atherosclerosis. Over time, plaque can harden and narrow the arteries. This limits the flow of oxygen-rich blood to your organs and other parts of your body. PAD usually affects the arteries in the legs, but it can also affect the arteries that carry blood from your heart to your head, arms, kidneys, and stomach.  People who have PAD may have symptoms when walking or climbing stairs, which may include pain, numbness, aching, or heaviness in the leg muscles. Symptoms may also include cramping in the affected leg(s) and/or in the buttocks, thighs, calves, and feet. Symptoms may ease after resting. These symptoms are called intermittent claudication.

Diagnosis

To determine if you have PAD, your physician will perform a test called an 'ankle-brachial index', which compares your blood pressure at your ankle to that of your upper arm. Those measurements should be about the same. If the blood pressure in your ankle is a lot lower, you may have peripheral arterial disease. An ultrasound, CT scan or MRI of your abdomen and legs may also be ordered to better visualize the blockage. If your case is severe, your physician may order an angiogram to understand exactly where the blockage is.

Treatment

For severe peripheral arterial disease, your doctor may recommend a minimally invasive procedure to bypass a blocked artery and restore blood flow. Treatments for peripheral artery disease (PAD) include heart healthy lifestyle, quitting smoking, medicines, interventional minimally invasive procedures and/ or surgery. The overall goals of treating PAD include reducing risk of heart attack, stroke, and reducing symptoms of claudication ( pain in your legs when walking). Treatment is based on your signs and symptoms, risk factors, and the results of physical exams and tests.
Treatment may slow, alter, or stop the progression of the disease. Without treatment, PAD may progress. This can result in debilitating disease resulting in your inability to heal ulcers/sores, increased risk of infection, inability to walk, and in the worst case scenario – limb loss. The Interventional Radiology physicians at RRIA will meet with you, evaluate your condition, order any non invasive imaging, and perform the needed procedures to get you back on your feet.

Abdominal Aortic Aneurysm (AAA)

In the past 30 years, the occurrence of abdominal aortic aneurysm (AAA) has increased threefold. AAA is caused by a weakened area in the main vessel that supplies blood from the heart to the rest of the body. When blood flows through the aorta, the pressure of the blood beats against the weakened wall, which then bulges, balloon like, into an aneurysm. If the aneurysm grows large enough, there is a danger that it will burst. Most commonly, AAAs occur in the portion of the vessel below the renal artery origins. The aneurysm may extend into the vessels supplying the hips and pelvis. Once an aneurysm reaches 5 cm in diameter, it is usually considered necessary to treat to prevent rupture. Below 5 cm, the risk of the aneurysm rupturing is lower than the risk of conventional surgery in patients with normal surgical risks. The goal of therapy for aneurysms is to prevent them from rupturing. Once an abdominal aortic aneurysm has ruptured, the chances of survival are low, with 80 to 90 percent of all ruptured aneurysms resulting in death. These deaths can be avoided if an aneurysm is detected and treated before it ruptures. Aortic stent graft placement is a less invasive means of fixing the aneurysm by making 2 incisions in the groin and fixing the aneurysm percutaneously/endovascularly.

Thoracic Aortic Aneurysm

A thoracic aortic aneurysm is an aortic aneurysm that presents primarily in the chest or thorax. A thoracic aortic aneurysm is the "ballooning" of the upper aspect of the aorta, above the diaphragm. If they go untreated or unrecognized, they can be fatal due to dissection or "popping" of the aneurysm leading to nearly instant death. Thoracic aneurysms are less common than an abdominal aortic aneurysm.

Indication for either surgery or a less invasive procedure may depend upon the size of the aneurysm. The size cut off for an aortic aneurysm is crucial to its treatment. A thoracic aorta greater than 4.5 cm is defined as aneurysmal, while a size greater than 6 cm is the distinction for treatment. Aneurysms in the ascending aorta may require surgery at a smaller size than aneurysms in the descending aorta. Treatment may be via open surgery or by interventional endovascular means.

Mesenteric artery stenosis

Mesenteric artery ischemia (MAI) is a condition that restricts blood flow to your intestines. There are 3 main arteries that supply blood to your small and large intestines. These are known as the mesenteric arteries. Narrowing or blocking the arteries reduces the amount of blood that travels to your digestive tract. When your intestines don't receive enough oxygen-rich blood, it can lead to serious health problems, including cell death and permanent damage; it can even be life-threatening. People of any age can develop MAI, but it's most common in adults over 60 years of age. Mesenteric artery ischemia has two types: acute and chronic. The acute form of the disease appears suddenly. Acute ischemia has severe symptoms. The chronic type of MAI has a more gradual onset. For most people, blood clots cause acute ischemia. Atherosclerosis is usually the cause of chronic ischemia.

Acute mesenteric ischemia is an acute emergency. Treatment with blood thinner medication, angioplasty/stent, thrombolysis, or surgery is indicated.

Chronic mesenteric ischemia is usually caused by a narrowing of the blood vessels due to atherosclerosis. An angiogram by an Interventional Radiologist will show the narrowing/stenosis and this may be treated with angioplasty/stent to improve blood flow to the bowel.

Renal Artery Stenosis

Renal artery stenosis is a narrowing of arteries that carry blood to one or both of the kidneys. Renal artery stenosis can worsen over time and often leads to hypertension (high blood pressure) and kidney damage. Initial treatment for renal artery stenosis is often medication. The condition may require 3 or more different drugs to control high blood pressure. Patients may also be asked to take other medications, such as cholesterol-lowering drugs and aspirin. In some cases angioplasty and stent placement may be performed to alleviate the stenosis. 

Thrombolysis

Catheter-directed thrombolysis treats vascular blockages and improves blood flow by dissolving the blockage. A blood clot, or thrombus, can block off the blood supply to certain parts of the body and cause serious damage. Catheter-directed thrombolysis uses x-ray imaging and a catheter to guide special medication or a medical device to the site of a blood clot to dissolve the blockage.