Peripheral Arterial Disease

The minimally invasive endovascular management of peripheral arterial disease (PAD) is preferred wherever appropriate. These are X-Ray based procedures, performed under local anaesthetic in order to improve the peripheral circulation.

Initially, the true extent of PAD is confirmed with detailed pictures obtained by injecting contrast directly into the arterial tree (‘angiography’). Following this, the narrowed/blocked vessel segment is crossed with a wire over which a balloon is advanced and inflated at the site of disease to widen/re-canalise the native artery (‘angioplasty’). Angioplasty is sometimes supplemented with deployment of a metal scaffold in order to hold the treated artery open (‘stenting’).

 

Femoral Artery Angioplasty: Significant arterial stenosis (narrowing) pre-treatment on diagnostic angiogram [left]. Angioplasty balloon inflated at across stenosis [centre]. Post-treatment image demonstrating much improved bloodflow [right]

 

Iliac Artery Angioplasty & Stent: Heavily calcified & stenosed Iliac artery on pre-treatment angiogram [left]. Balloon angioplasty prior to stent placement [centre]. After successful stent deployment [right]

 

In patients where PAD is extensive or where attempts at endovascular therapy would be futile or have already failed, surgery may be advised. Typically, this requires either direct disease excision and repair of the artery (‘endarterectomy’) or surgical bypass of the diseased length of blood vessel. ‘Hybrid’ procedures are sometimes required and these involve a combination of both open surgery and intra-operative endovascular techniques for re-vascularisation.

 

Femoral Endarterectomy

 

Surgical bypass for PAD