Aortic & Peripheral Vascular Interventions

Peripheral Artery Disease (PAD) is a condition where narrowed or blocked blood vessels reduce blood flow to the limbs. This narrowing is usually caused by atherosclerosis, a build-up of plaque (fat, cholesterol, and other substances) in the artery walls, leading to reduced blood flow and potential complications.

Complications –   

• Acute limb ischemia (ALI) is a sudden, dangerous decrease in blood flow to a limb that threatens its viability. It’s a vascular emergency requiring immediate diagnosis and treatment to prevent limb loss. ALI can be caused by several factors, including emboli, thrombosis, or trauma.
• Critical Limb Ischemia (CLI): Reduced circulation causes chronic pain, sores, or infections in the legs and feet, potentially leading to tissue death (gangrene) and amputation.
• Non-Healing Wounds & Ulcers: Poor blood flow slows the body’s ability to heal, increasing the risk of infections that may become life-threatening.
• Infections & Gangrene: Reduced immunity and circulation can lead to severe infections, which may require surgical intervention or, in extreme cases, limb amputation.

Management –  video of PAD

• Smoking cessation is crucial
• Multidisciplinary approach: Managing PAD often involves a team of healthcare professionals, including vascular surgeons, cardiologists, and podiatrists
• 2 main types of revascularisation treatment for PAD:
• Angioplasty – where a blocked or narrowed section of artery is widened by inflating a tiny balloon inside the vessel
• Artery bypass graft – where blood vessels are taken from another part of your body and used to bypass the blockage in an artery

CO2 ANGIOGRAPHY

CO2 angiography is a medical imaging technique that uses carbon dioxide gas as a contrast agent to visualize blood vessels.

How it works

1. CO2 injection: Carbon dioxide gas is injected through a catheter into the blood vessel.

2. Imaging: X-ray or fluoroscopy images are taken to visualize the blood vessel.

Benefits

1. CO2 is not nephrotoxic, making it suitable for patients with kidney disease.
2. Alternative to iodinated contrast
3. Effective imaging: Provides clear images of blood vessels.

EVAR

Endovascular Aneurysm Repair (EVAR) is a minimally invasive procedure used to treat aneurysms in the aorta, the major artery carrying blood from the heart. It involves inserting a stent-graft through an artery in the groin to reinforce the weakened area of the aorta and prevent rupture

 Benefits of EVAR:

EVAR is considered less invasive than open surgery, leading to a shorter hospital stay and faster recovery. It also reduces the risk of complications associated with large incisions and prolonged surgery.

 

Risks of EVAR:

EVAR carries some risks, including bleeding, infection, and damage to surrounding blood vessels or organs

FEVAR

FEVAR (Fenestrated Endovascular Aneurysm Repair) is a type of endovascular procedure used to treat complex aortic aneurysms.

FEVAR Details

Complex aneurysm treatment: That involve branching arteries.

stent-graft with fenestrations (small holes) is used to preserve blood flow to vital organs.

VENOPLASTY

Venoplasty is a common treatment for venous stenosis in dialysis patients with arteriovenous fistulas (AVFs).

Benefits

1. Improved patency: Venoplasty can improve AVF patency and function.

2. Reduced thrombosis risk: By treating stenosis, venoplasty can reduce the risk of thrombosis and AVF failure.

3. Maintained dialysis access: Venoplasty helps maintain functional AVF access for dialysis.

Procedure

1. Balloon angioplasty: A balloon catheter is used to dilate the stenotic vein segment.

2. Stent placement: In some cases, a stent may be placed to maintain vein patency.