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Arterial Disease



  • A narrowing and hardening of the arteries due to blood vessel plaque.

  • Often a silent disease that worsens health by blocking blood flow in the arteries

  • Loss of oxygen and nutrients from blocked arteries causes tissue injury (brain, heart, legs) and death.

Peripheral Arterial Disease "PAD"

  • Plaque within the blood vessel restricts blood flow, oxygen and nutrients.  

  • Complications of PAD in the leg includes pain with walking, slow-healing wounds, and potential loss of a limb.

  • Complications of PAD in the neck and brain include a mini-stroke (resolves in minutes)  or a permanent stroke.

  • Complications of PAD in the  heart vessels PAD  include heart injury (ischemia, arrhythmia) and heart death (infarction).


Life threatening conditions:

      • Stroke

     • Heart attack

     • Limb loss and Gangrene

Additional conditions include:

     • Claudication (cramping leg pain when walking)

     • Rest Pain (cramping feet at rest, relieved with standing or massage)

     • Mini-stroke (low oxygen levels in the brain)

     • Myocardial ischemia (low oxygen levels in the heart muscle)

     • Ulcers (low oxygen levels to the skin, muscle, and nerves)

     • Impotence (low oxygen levels to the genital organs)


*Disclaimer- The information provided is for informational purposes only.

PAD Management


Risk of PAD: PAD  affects approximately 14% to 20% of adults

• Symptoms:

     •Asymptomatic PAD - 75% have no significant symptoms (Asymptomatic PAD)

     • Symptomatic PAD

                • Intermittent Claudication (IC): leg pain with walking which stops with rest

                 Critical limb ischemia (CLI): leg pain with walking and at rest

• Marker: PAD in the legs increases risk for having PAD of the heart and brain


• Outcomes:

                • IC PAD: 1 in 4 persons will have worsened symptoms a year after diagnosis

                •  CLI PAD:

                         • 5-year mortality  risk is 50% to 70% 

                         •  35% of deaths are from other PAD causes (heart attack, stroke)

                         • 1 in 3 persons have an amputation1 year after diagnosis

                • Asymptomatic PAD - same outcomes as IC


Diagnosis :

          • History

          • Physical examination

          •  Vascular laboratory testing

                      • Ankle–brachial index (ABI) with Toe-brachial index (TBI) examination                                   (ABI with TBI repeat testing is the best predictor of worsening PAD)

                      • Other tests include ultrasound, CT scan, MRI, surgical arteriogram         

Treatment : Prevention of risks for heart attacks and stroke

         • medicine for high cholesterol (statins)

         • medicine for high blood pressure

         • medicine for diabetes

         • medicine for reducing inflammation (Aspirin, Plavix® /Clopidogrel)

         • Stop smoking

          • Regular exercise program ± Medicine (Pletal®/Cilostazol)


        • Vascular specialists are critical in diagnosing PAD from other causes of leg                     pain and symptoms (e.g. varicose veins, sciatica, autoimmune disorders). 

        • SANO routinely performs ABI with TBI and arterial ultrasound imaging  

        • SANO reserves  CT, MRI, or surgery for obtaining  other valuable information 

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*Disclaimer- The information provided is for informational purposes only.

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Open Surgery Techniques

  1. Damaged arteries may be opened to remove plaque

    • An incision is made over the damaged artery after dissection​

    • Plaque is removed from the inner wall of the artery (endarterectomy)

    • Material is sewn to the artery incision to widen it (patch angioplasty)

    • A blood tube is used to connect an artery to another artery (bypass)

  2. Options for blood vessel treatment often include:

    • Patch angioplasty (using vein, artery, or man-made material)

    • Vein bypass (using  vein to connect 2 artery areas)

    • Prosthetic bypass (using man-made tube to connect 2 artery areas)

    • Endarterectomy (removal of plaque and closing the artery incision)

Benefits of Open Surgery

  • Direct visualization  and repair of the damaged vessels

  • Less future interventions anticipated, compared to endovascular

  • Long-term durability, compared to endovascular

Concerns of Open Surgery

  • Longer recovery time to heal incisions

  • Higher risk of postoperative pain 

  • Increased risk of infection (e.g. pneumonia, incision site)

  • Higher anesthesia risk with less-healthy patients

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*Disclaimer- The information provided is for informational purposes only.

Open Surgery


Endovascular Surgery


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What is Endovascular Surgery?

  • Surgery performed from inside the artery using wires, catheters, balloons. and stents

  • There is rarely a need for use the large incisions seen in open surgery

  • Hybrid procedures, involve endovascular and open surgery technique     


Endovascular Procedure Steps

  1. The blood vessel of the arm and/or leg are accessed with a needle

  2. Wires and catheters are used to dilate the needle access site

  3. Blocked arteries are identified using an x-ray screen and/or ultrasound in a specially equipped room

  4. Wires, catheters, Balloons, stents, and rotating devices may be used to open and widen the narrowed or blocked artery


Endovascular techniques commonly used (individualized to each patient)

  • Angioplasty- A balloon is dilated in an artery to widen it

  • Stenting- a cylindrical tube expands in the artery to widen it long-term

  • Atherectomy- catheters rotate in plaque  to widen areas in the artery 

  • Pharmaco-mechanical thrombolysis-catheters and medicine are used to  dissolve recent blood clots 











Why use Endovascular Surgery?

  • Reduced hospital stay                     

  • Quicker return to work and normal activities.

  • May be performed with local anesthesia and minimal sedation.

  • Decreases anesthesia risks in less-healthy patients

What are the common risks?

  • Overall rate of complications is less than 1%.

  • Bleeding

  • Infection

  • Need for additional and possibly an open procedure

  • Allergy to contrast

  • Often requires a patient have normal or near-normal kidney function



*Disclaimer- The information provided is for informational purposes only.

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