Research presented today
shows angioplasty and stenting can prevent amputation and restore blood
flow in the lower extremities of patients with severe critical limb
ischemia and gangrene (tissue loss). At eighteen months, the tiny arteries
below the knee remained open, with a ninety-one percent success rate, thus
preventing amputation. This success rate was consistent in all patients who
were consecutively enrolled over a six-year period of time. The blockages
were caused by peripheral arterial disease (PAD), “hardening of the
arteries,” the same disease which can lead to heart attack and stroke. The
smaller blood vessels below the knee are more difficult to treat due to
their size (3mm) and are more prone to reclog than larger vessels. The
research was presented today at the Society of Interventional Radiology’s
32nd Annual Scientific Meeting.
“This study shows that with angioplasty and stenting, we can restore
blood flow through the smallest vessels in the legs and keep them open
long-term, saving these patients from life-altering amputation,” says lead
author Nael Saad, M.D., interventional radiologist, University of Rochester
Medical Center, Rochester, New York. “Aggressive interventional therapy
should be considered in all patients as a first option. In general, the
long-term clinical results are comparable to by-pass surgery in the leg
using a longer, more complex graft, but with a much lower risk of morbidity
and mortality.”
About the Study
Forty-seven patients had eighty-one blockages treated that were below
the knee. Sixty-six percent were men with a mean age of seventy-three. The
patients had the following risk factors that are also indicative of PAD:
— 85% smoking history
— 62% cardiac history
— 91% hypertensive
— 55% diabetic
— 53% kidney disease
— 53% obese
— 60% hyperlipidemia
Primary patency using angioplasty and/or stenting was seventy-five
percent at three months and fifty-five percent at 18 months. By re-treating
the artery that became re-clogged, the artery remained open, saving the
limb in ninety-one percent at 18 months follow-up. Abstract 111 can be
found at SIRmeeting.
About Peripheral Arterial Disease
Peripheral arterial disease (PAD), also known as peripheral vascular
disease (PVD), is a very common condition affecting 12-20 percent of
Americans age sixty-five and older. PAD develops most commonly as a result
of atherosclerosis, or “hardening of the arteries,” which occurs when
cholesterol and scar tissue build up, forming a substance called plaque
inside the arteries that narrows and clogs the arteries. PAD is a systemic
disease — clogging in one area of the body (legs) indicates clogging is
occurring in other parts of the body (heart).
— PAD is a disease of the arteries that affects ten million Americans
— PAD can happen to anyone, regardless of age, but it is most common in
men and women over age fifty
— PAD affects 12-20 percent of Americans age sixty-five and older
About Angioplasty and Stenting for Treating PAD
Using imaging for guidance, the interventional radiologist threads a
catheter through the femoral artery in the groin to the blocked artery in
the legs. He then inflates a balloon to open the blood vessel where it is
narrowed or blocked. In some cases, this is held open with a stent, a tiny
metal cylinder. This is a minimally invasive treatment that does not
require surgery, just a nick in the skin the size of a pencil tip. In
general, balloon angioplasty and stenting has replaced invasive surgery as
the first-line treatment for PAD. Randomized trials have shown
interventional therapy to be as effective as surgery for many arterial
occlusions and, in the past five to seven years, a very large clinical
experience in centers throughout the world has shown that stenting and
angioplasty are preferred as a first-line treatment for more and more
processes throughout the body. Although PAD in general is treated
nonsurgically, in many cases the superficial femoral artery is still being
treated surgically.
About the Society of Interventional Radiology
Interventional radiologists are board-certified physicians who
specialize in minimally invasive, targeted treatments. They offer the most
in-depth knowledge of the least invasive treatments available coupled with
diagnostic and clinical experience across all specialties. They use X-rays,
MRI and other imaging to advance a catheter in the body, usually in an
artery, to treat at the source of the disease nonsurgically. As the
inventors of peripheral angioplasty and the catheter-delivered stent,
interventional radiologists pioneered minimally invasive modern medicine,
and provide treatments that offer less risk, less pain and less recovery
time compared to open surgery. More information can be found at
SIRweb.
Society of Interventional Radiology
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