Peripheral Vascular Disease
Peripheral Vascular Disease Treatment continued...
Angioplasty is not a permanent solution for most people. Stenting is a technique for arteries that are very severely blocked or begin to close up again after angioplasty.
- Generally, after the stent is placed, angioplasty is carried out. Stenting and angioplasty are very useful if the obstructive lesions are localized and involve a small portion of the vessel. 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.
- The stent holds the artery open.
- Eventually, new tissue grows over the stent. A bare metal stent was the initial approach. However, development of restenosis or fibrous scar tissue growth inside the stent leads to recurrent obstruction.
- A new generation of drug-eluting stents is especially exciting, since a drug is attached to the metal sleeve that dissolves into the blood and prevents growth factors acting to develop scar tissue. The rate of restenosis has decreased.
- 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 peripheral vascular disease. Medications used to treat peripheral vascular disease and intermittent claudication include those that aim to lower the risk and progression of atherosclerosis throughout the body, such as those to help stop smoking, lower blood pressure, lower cholesterol, and optimize the blood sugar in people with diabetes.
Two medications have been approved by the United States Food and Drug Administration (FDA) for direct treatment of the symptom of intermittent claudication.
- Pentoxifylline (Trental): How this drug helps in intermittent claudication is not completely understood. It is believed to improve blood flow by decreasing the viscosity of blood and making red blood cells more flexible. With these alterations, the blood can move more easily past obstructions in the blood vessel.
- 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.
Sudden blockage of an artery by a blood clot (thrombus) has been treated with medication for many years. Choices include antiplatelet agents, anticoagulants, and "clot-busters" (thrombolytics).
- Antiplatelet agents include aspirin, ticlopidine, and clopidogrel. These agents do not get rid of an existing clot. They prevent further clots from forming by keeping blood cells and platelets from clumping together.
- Anticoagulant agents include heparin, warfarin (Coumadin), enoxaparin (Lovenox), vorapaxar (Zontivity), and low-molecular-weight heparin: These agents also do not remove an existing clot. They interfere with the sequence of blood clotting factors that causes a clot to form.
- Thrombolytics: These are powerful drugs that can actually dissolve an existing clot. They can be used only under certain circumstances and are given only in the hospital. They can be injected directly into the blocked artery under angiographic guidance. To be effective, they have to be administered intravenously within the first 4-8 hours after a patient develops symptoms.