Peripheral Arterial Disease
Peripheral arterial disease (PAD) commonly results from atherosclerosis as cholesterol and scar tissue build up along vessel walls. Occlusion of the vessel lumen results in decreased blood flow to the legs, which can lead to intermittent claudication, and eventually gangrene and amputation. Symptoms include painful cramping in the leg or hip that occurs when walking or exercising and typically disappears when the person stops the activity, numbness or tingling in the legs/feet, and pain in legs/feet at night. Interventional radiologists can treat PAD using angioplasty and stenting
, which involves inserting and inflating a balloon to open the narrowed artery and keeping the vessel open with a cylindrical mesh. Atherectomy can be performed which involves inserting a small catheter at the site of blockage that is able to "shave" the plaque from inside of the artery to re-establish normal blood circulation.
Varicose veins are enlarged, swollen vessels that develop when weak valves allow blood to flow backwards and pool. Symptoms include aching, throbbing, fatigue, and weakness that worsen as the day goes on. Interventional radiologists can treat varicose veins using endovenous ablation. In this procedure, laser or radiofrequency is applied via a catheter to the inside of the abnormal saphenous vein to seal it closed.
Deep Vein Thrombosis
Deep vein thrombosis (DVT) is formation of a blood clot in the deep leg vein, and can lead to permanent damage to the leg (post-thrombotic syndrome) and life-threatening pulmonary embolism. Contractions of the muscles surrounding the deep leg veins and arterial-venous pumps help return blood to the heart against gravity. One-way valves prevent the back-flow of blood between contractions. Slowing of blood circulation due to illness, injury, or inactivity promotes clot formation. Interventional radiologists can treat DVT with catheter-directed thrombolysis, balloon angioplasty, or stenting
. Catheter-directed thrombolysis involves inserting a catheter into a vein in the leg to deliver tPA to dissolve the blood clot. Patients who are not ideal candidates for catheter-directed thrombolysis can be treated with the insertion of an IVC filter
, a small umbrella-like device inserted in the inferior vena cava to capture blood clots and prevent occlusion of vital vessels.
Pulmonary embolism is usually due to thromboembolus from deep vein thrombus involving the femoral, iliac, or popliteal veins. DVT can break up and travel via the blood circulation to the lung where it occludes critical blood supply. Symptoms include shortness of breath, rapid pulse, sweating, sharp chest pain, and bloody sputum. Occlusion of both left and right pulmonary arteries (large saddle embolus) or significant occlusion of a large pulmonary artery can result in sudden death. Interventional radiologists can treat pulmonary embolism by fragmentation of embolus with angiographic catheters. Thrombolytic agents can also be administered similar to treatment of DVT.