Peripheral Arterial Disease (PAD) affects approximately 20% of men and women aged 55 years and older1. PAD also affects approximately 30% of patients over 50 years of age that have a history of smoking or diabetes mellitus2. The prevalence of intermittent claudication associated with PAD also increases with age. Four percent (4%) of the patients with intermittent claudication will require amputation and 25% will have worsening symptoms or require lower extremity revascularization3. Many people mistake the symptoms of PAD for something else or assume that they are a normal part of aging. Because PAD is a marker for diabetes, hypertension and other conditions, the Society of Interventional Radiology is recommending expanded screening efforts such as the Legs for Life national awareness program4.
Treatment options for PAD range from conservative pharmaceutical management, for those in whom the disease does not progress, to intervention to restore blood flow. While bypass surgery is the "gold standard," it is not without considerations and risks. Since the patients with PAD have systemic atherosclerosis, harvesting the saphenous vein may not be advisable or available in patients with prior coronary artery bypass graft (CABG) surgery. Often these patients have significant other comorbidities that increase the risks of surgery.5
Percutaneous revascularization is becoming a viable alternative to surgery in the treatment of PAD. A variety of methods normally used in coronary arteries are being employed to restore circulation to the lower extremities. Balloon angioplasty, stents, laser atherectomy and plaque excision are current means used to open occluded vessels in the lower limbs.
Advantages of percutaneous techniques include less procedure time, ease of use, faster patient recovery, decreased systemic complications, repeatability in light of new occlusions and hope for non-surgical candidates6. The potential of treating PAD by means of less invasive techniques has arrived giving alternatives to both patients and physicians.
1 Meijer WT, et al: Peripheral arterial disease in the elderly: The Rotterdam Study. Arteriosclerosis, Thromb Vasc Biol 1998; 18(2): 185-192.
2 Hirsh AT, et al: Peripheral arterial disease detection, awareness, and treatment in primary care. JAMA. 2001; 286(11): 1317-24.
3 LaPerna L, Diagnosis and medical management of patients with intermittent claudication. JAOA 2000; 100(10); S10-S14.
4 Legs for Life website: Peripheral Arterial Disease. August 2005. www.legsforlife.org
5 Tucker De Sanctis J. Percutaneous Interventions for Lower Extremity Peripheral Vascular Disease. Amer Fam Phys 2001; 64:1965-1972.
6 Baim DS, et al. Randomized Trial of a Distal Embolic Protection Device During Percutaneous Intervention of Saphenous Vein Aorto-Coronary Bypass Grafts. Circulation. 2002; 105:r13-r18.