Peripheral and Endovascular Service
Peripheral arterial disease affects almost 10 million patients, yet it remains one of the most underdiagnosed and undertreated conditions. In some patients clogged arteries are not limited just to the heart. Cholesterol plaques can affect the arteries of the neck (carotid arteries), kidneys (renal arteries), aorta, and arteries of the legs and arms. Peripheral arteral disease can result in leg or arm discomfort while exercising, leg ulcers and other serious complications.
Our team of specialists includes experts in both diagnostic imaging and endovascular procedures who are specially trained to detect abnormalities in the vascular/circulation system and who focus specifically on detection and treatment of peripheral arterial disease. These vascular specialists are board certified in vascular or endovascular medicine, cardiovascular disease, and interventional cardiology and are fellowship trained with additional specialization in vascular procedures.
Noninvasive Vascular Imaging
To accurately diagnose abnormalities in the vascular system, our specialists rely on noninvasive tests that use cuffs similar to those used to measure arm blood pressure and ultrasound technology (see Vascular Imaging section). These tests can be conveniently performed at the same location and during a regular office visit and include:
- Ankle-brachial index (ABI)
- Treadmill exercise test
- Pulse volume recording (PVR)
- Arterial and venous (Doppler) ultrasound
Other diagnostic tests and techniques include
- CT angiography (CTA)
- Magnetic resonance angiography (MRA)
A Multidisciplinary Approach To Peripheral Artery Disease
The Endovascular Cardiology Service offers a comprehensive, multispecialty, cutting-edge approach to the evaluation and care of patients with peripheral arterial disease, with an emphasis on a minimally invasive endovascular approach.
We will work closely with the patient and referring physician to coordinate personalized treatment plan for every patient. Our goal is to create an individualized approach to diagnose and treat peripheral arterial disease, improve our patients’ lifestyle and prevent any vascular complications. In addition, we focus on prevention of future vascular problems by providing guidance regarding smoking cessation and life style modifications. All of our vascular specialists are board certified in cardiology and will be able to diagnose and treat associated cardiac conditions if necessary. We use multidisciplinary approach to treating peripheral arterial disease:
Medical therapy: Medical therapy is an integral part of treatment for all patients with peripheral arterial disease. Medications are used to target leg or arm discomfort that occurs with exertion and due to clogged arteries. Medications are also used to treat diabetes, hypertension and high cholesterol.
Exercise therapy: Exercise therapy can help patients increase the distance and speed with which they can walk without pain.
Smoking cessation: Guidance on smoking cessation and detrimental effects of smoking
Lifestyle changes: These changes are important for prevention of future vascular complications.
Minimally invasive endovascular approach: This approach is used by our experienced interventional cardiologists that specialize in performing percutaneous procedures through a small puncture in the groin or arm, resulting in a short recovery period from the procedure, as opposed to traditional surgical techniques. Clogged arteries can be treated with balloon angioplasty, placement of stents, or atherectomy (plaque excision from the artery).
Areas Of Endovascular Expertise:
Angioplasty and stenting for peripheral arterial disease: The operators use a small balloon-tipped catheter that is threaded through the clogged artery to expand it. A stent may be inserted to relieve the blockage and to keep the artery open. Bare metal stents or novel drug-eluting stents are used to treat clogged arteries.
Chronic total occlusions: Our experienced operators can relieve blockages in the arteries that are completely blocked, particularly blockages that have been present for months and sometimes for years.
Limb ischemia: Treatment of patients with leg or arm discomfort at rest, presence of ulcers or gangrenes.
Atherectomy (plaque excision): A catheter is being used to remove the plaque from the artery. Our specialists use cutting-edge technology, including rotational, excisional, orbital, and laser atherectomy.
Renovascular disease: Clogged renal arteries can lead to hypertension, that is difficult to treat with medications, kidney failure or heart failure. These clogged kidney arteries can be treated with angioplasty and stenting.
Intravascular Ultrasound and Fractional Flow Reserve (FFR): An ultrasound catheter can be threaded through the clogged artery to determine the severity and location of a given blockage. A Fractional Flow Reserve wire is threaded through a blockage and used to measure whether the blockage is detrimental and requires further treatment.
Inferior Vena Cava filter placement and retrieval: Small filter devices are placed in a large vein (vena cava) to prevent clots from traveling to the lungs. These devices can be used for both prevention and treatment of patients with clots formed in deep veins.
Carotid disease and carotid stenting: Carotid artery angiography and stenting (with filter devices in the arteries of the neck that catch plaque particles) can be performed for patients with severe blockages of carotid arteries, particularly in those experiencing strokes or ministrokes.
Active Studies Recruiting Patients:
Novel device evaluation in endovascular treatment of peripheral artery disease.
Clinical evaluation of various antithrombotic and antiplatelet adjunct pharmacological agents in endovascular interventional procedures.
Clinical investigation of novel, catheter-based approaches for the treatment of refractory hypertension (renal denervation).
Clinical evaluation of patients with carotid artery disease
Novel inferior vena cava filter device evaluation.