Peripheral arterial disease (PAD) affects millions of Americans each year. PAD represents a spectrum that ranges from asymptomatic disease, to intermittent claudication, to its most severe form – chronic limb- threatening ischemia. The latter is particularly prevalent among our most infirm patients, those with diabetes mellitus and those with chronic kidney disease. Fortunately, our ability to diagnose PAD continues to improve with more widespread use of non-invasive vascular studies and early referral to vascular specialists.
Comprehensive Vascular Services
In the Vascular Surgery department at The Polyclinic Broadway, we have wide-ranging vascular capabilities including the ability to diagnose these conditions
in our vascular lab, evaluate patients in our vascular surgery clinic offices, and treat them in our Vascular Interventional Radiology suite.
Our typical approach starts with reviewing the history and evaluating the patient with non-invasive ultrasound studies to determine the degree and extent of disease. This helps us assess the impact of our interventions and long-term surveillance. Once our evaluation is complete, we develop a formal plan for revascularization.
Fully Equipped IR Suite
Within our Interventional Radiology suite, we can manage patients with limb ischemia. In addition to having basic angiographic equipment (C-arm with fluoroscopy capability, wires, catheters, balloons, stents, and atherectomy devices), we also have access to specialized equipment that allows us to perform vascular procedures through alternative sites, use less radiation, minimize contrast use, and precisely measure vessels to tailor treatment to the unique anatomy of the patient.
When alternative access is preferred, we have performed angiographic procedures through the radial artery at the wrist or through the tibial arteries at the ankle or foot. This helps us avoid the complications associated with groin access. It also reduces patient recovery time to an hour versus requiring the patient to lay flat for two to four hours when conventional access is used. In addition, we may use alternative access when we are unable to cross a blockage from above, as certain types of plaque are more amenable to crossing from below.
In many cases, we also perform intravascular ultrasound. This has been a great advantage in confirming that our wire is in the true lumen of the vessel (which can be difficult to determine when crossing blockages). It also allows precise vessel measurements, which are crucial when selecting the size of the balloon or stent to use.
This method ensures we are not undertreating an artery or damaging it. Another distinct advantage of using ultrasound is the ability to gather more information without exposing the patient to more radiation or iodinated contrast. For comparison, a typical CT angiogram of the abdomen and pelvis uses about 120mL of contrast. In our IR suite, we have performed arterial revascularizations with 20-40mL.
Our experienced nurses keep our patients at ease and this often minimizes the amount of medications they need. All of this results in being able to perform highly complex arterial revascularizations in a safe and comfortable environment.