What is PAD?
PAD is when the blood flow to an artery is blocked. It is caused by plaque or atherosclerosis within the artery. This is most common in the leg. It is a lot like when an old pipe develops build up inside that blocks the flow of water. Most common area for PAD is the legs. When PAD is mild or moderate, it can cause leg cramping when you walk. When it gets more severe, it can cause leg pain at rest, ulcers of the toes or foot can develop, or even gangrene.
How do we treat PAD?
In general, PAD is treated with a procedure which “opens up” the blockage that was created by the build-up of plaque. Different techniques can be used depending on the location, appearance, and extent of the blockage. The usual treatments include angioplasty (balloon dilation), atherectomy (using a catheter to shave out some of the blockage), laser (vaporizing the plaque), stents (metallic scaffolds placed to hold open an angioplasty site), and stent-grafts (stents with a covering that hold open an angioplasty site). Sometimes we also deliver medicine to the site of blockage to dissolve blood clot (thrombolysis). Any or all of these techniques may be done during your procedure. When we puncture the artery at the groin we often use a puncture sealing device to prevent bleeding.
Do I need to treat this?
You have symptoms or findings related to PAD. The purpose of the procedure is to treat the blood flow issue and improve blood flow to your leg or foot. This will hopefully help relieve pain and allow better healing of an ulcer or at a place where surgery was done (or will be done) to allow the tissue to heal.
What are the benefits and risks of the procedure?
Minimally invasive angiogram for peripheral vascular disease offer patients numerous benefits, including:
Faster recovery time
Lower risk of complications
The use of a sedative instead of general anesthesia, so patients can go home the same day
Damage to the treated blood vessel
Complete closure of the blood vessel
How is the procedure performed?
Your procedure will be done at El Camino Hospital where you will be set up with an IV to allow access for moderate, also known as “twilight” sedation. You will then be taken to the procedure room where you will have a team of two nurses, a radiology technician and your interventional radiologist. You will be connected to heart, blood pressure and oxygen monitors during the entire procedure. IV medication will be administered to make you comfortable (moderate sedation). Then your interventional radiologist will administer numbing medication (local anesthetic) to the procedure site. Using fluoroscopy guidance (X-ray) a catheter will be inserted through an artery. An angiogram using fluoroscopy (x-ray) guidance is performed where a small amount of contrast dye will “map” out the small arteries and help locate the narrow or blocked vessels. Once these vessels are identified, depending on this issue, one or multiple interventions may be done such as angioplasty, atherectomy, laser, stent placement, and stent-graft placement. After the targeted area is treated, a repeat angiogram is done to confirm successful patency and blood flow through the treated artery. Once all sites are evaluated and treated, the catheter is then removed and a seal is placed at the procedure site. The procedure takes about 30-60 minutes.
What can I expect after the procedure?
You will be taken to recovery for about 2 hours where your blood pressure, heart rate, oxygen saturation, procedure site and legs are monitored. You will be able to eat and drink during this time and any family members or friends will be able to see you shortly while in recovery.
Following the procedure you should rest for the remainder of the day at home. You should avoid strenuous exercise for at least 24 hours after the procedure, and may be given a blood-thinning medication to avoid the formation of blood clots while the treated area(s) heals.
What should I watch for?
During the procedure at least one puncture was made into the artery, often at the groin. Sometimes several punctures at different sites are required. When you leave the hospital there may be some bruising or swelling at the puncture site(s). You should keep the puncture site(s) covered with a bandage (band aid is fine) for several days. If you notice an increase in pain, swelling, redness, or tenderness, contact your interventional radiologist at 650-404-8445 during M-F daytime, or go to the ER if you have concerns at other times.
If you received sedation on the day you are discharged you should not drive, consume alcohol, operate heavy machinery or make any important decisions for the remainder of the day.
You may shower tonight. Your procedure site is sealed with skin glue that should fall off on its own in about 1-2 weeks.
You may use over the counter medication such as Acetaminophen (Tylenol) or Ibuprofen (Advil /Motrin) for minor discomfort, unless you are restricted from taking these medications.
If you feel that Tylenol or Advil are not enough for pain control, please contact the Vascular and Interventional Radiology Clinic at 650-404-8445.
You can resume your normal diet. Some patients may develop nausea after sedation. Therefore light meals are recommended until you know that you can eat without problems.
When should you call your physician ?
Fever or chills > 101.5 F
Worsening of swelling, tenderness, redness or worsening of pain in the procedure area
Recurrence or worsening of leg or foot pain
Worsened circulation in the leg(s)
You can reach your Interventional radiologist at 650-404-8445 during M-F 8-5pm, or the physician can be reached through the operator after hours or on weekends by calling 408-739-6000 and asking for the Interventional Radiologist “on call.”