Peripheral Vascular Disease
Peripheral Vascular Disease Treatment continued...
Stenting is a technique for arteries that are severely blocked or begin to close up again after angioplasty.
- The majority of peripheral vascular lesions can be managed by placement of a stent, a small metal mesh sleeve that is fixed inside the narrowed artery.
- Stenting and angioplasty are very useful if the obstructive lesions are localized and involve a small portion of the vessel. Generally, the stent is placed during or after angioplasty.
- The stent holds the artery open. Eventually, new tissue grows over the stent.
- There are two types of stents that can be used: A bare metal stent was the initial approach. However, development of fibrous scar tissue inside the stent can lead to obstruction coming back. The problem is being addressed with a new generation of "drug-eluting" stents. A drug is attached to the metal sleeve that dissolves into the blood and prevents or slows the development of scar tissue.
Atherectomy is removal of an atherosclerotic plaque. A tiny cutting blade is inserted into the artery to cut the plaque away.
Whether medication is a good choice for you depends on the underlying cause of your PVD. Medications used to treat PVD and intermittent claudication include those that aim to lower the risk and progression of atherosclerosis throughout the body. That includes medicines that help you stop smoking, lower blood pressure, lower cholesterol, and optimize blood sugar if you have diabetes.
Several medications are available to treat the symptoms of intermittent claudication -- pain as a result of narrowed or blocked blood vessels:
- Cilostazol (Pletal): This drug keeps platelets from clumping together. This clumping promotes formation of clots and slows down blood flow. The drug also helps dilate, or expand, the blood vessels, encouraging the flow of blood.
- Antiplatelet agents include aspirin, aspirin plus dipyridamole , ticlopidine, and clopidogrel. They prevent clots from forming by keeping blood cells and platelets from clumping together. They may be given to help prevent heart attack and stroke.
- Pentoxifylline (Trental): This drug is believed to improve blood flow by making red blood cells more flexible and making the platelets less sticky. Recent studies have questioned the effectiveness of pentoxifylline.
Medications to help prevent the development and progression of atherosclerosis such as cholesterol lowering medicines are also very important.
When the obstructive lesions are long and involve most of the vessel, surgery may be the best alternative. The most widely used operation for a blocked or damaged artery is called a bypass. This is similar to the artery bypass operation done on the heart.
A piece of vein, harvested from another part of your body, or a piece of synthetic artery is used to bypass or detour the obstructed segment of disease, therefore restoring blood flow to the downstream or distal portion of the artery.
Surgery is required less often today, as better preventative anti-atherosclerotic medications and techniques have become available for treating blocked or damaged arteries. With modern treatments, surgery is required only for very severe atherosclerosis that's unresponsive to medications and angioplasty.