Peripheral Vascular Disease

To become a vascular surgeon, one typically must complete five years of training in general surgery before training an additional year or two on diseases of the blood vessels.

An understanding of PVD requires considerable background about the circulatory system and the components of the heart. To survive, the human body depends upon blood circulation by way of arteries (which carry blood, replenished with oxygen and nutrients, from the heart into the tissues of the body) and veins (which carry blood from the body back to the heart). In an adult human, this getting-and-giving supply cycle repeats around 70 times per minute.

All organs and tissues in our body, including the heart itself, depend on arteries for the transference of oxygen and nutrients. When cholesterol builds in coronary arteries, the blockage that results induces a heart attack (also called a myocardial infarction), which is the leading cause of death in the US.

The heart’s arteries can be aggravated by such common conditions as high blood pressure and diabetes, all of which are linked to lifestyle choices such as high-fat and high-sugar diets and a failure to regularly exercise. The coronary arteries are not the only victims of our indulgent behaviors, however: all of the body’s arteries are subject to the dangers of an unhealthy or frequently inactive lifestyle. Though coronary arteries are the most susceptible to health concerns, other commonly-affected arteries include those in the legs, as well as the main large artery extending from the heart to the rest of the body, which is called the aorta.

For many years, advancing surgical techniques have allowed surgeons to successfully treat blockage of these arteries by borrowing segments of “less important” veins and by using them to bypass blockages. These are major surgical procedures, performed while a patient is under general anesthesia for several hours, and require that surgeons make large incisions in the body to get to the arteries in question. In the case of coronary artery bypass, the patient’s chest is opened, the heart is exposed, and the body’s blood circulation is briefly regulated by a machine while the arteries of the heart are bypassed.

More recent medical techniques allow arterial blockages to be treated without need for invasive surgery. Often these procedures are done with local anesthesia, and are known as “interventional radiological techniques.” During such techniques, doctors insert a needle into the patient’s skin, puncturing into an artery in the upper part of the thigh. Long narrow tubes called catheters can then be inserted without general anesthesia or large incisions. A bright dye called “contrast” is then allowed to flow through these catheters, ultimately allowing blood vessels to show up on an x-ray like roads on a map.

The same catheters used for the flow of contrast can also be inserted in the arteries to carry small tubular devices. These devices begin in collapsed form on the end of a long tube (called a “cannula”), allowing a stent to be positioned across the inside of arterial blockages. When the stent is released or deployed, it springs open, pushing the blockage aside and restoring passage for the flow of blood.

As interventional technologies improve, so does the expertise of the professionals who use them, resulting in the ability to treat increasingly complex types of blood vessel blockages. Many skilled vascular surgeons today find that they seldom need to make conventional deep incisions into the bodies of their patients. Because of continually evolving medical capabilities, the chances of surgical complication are diminished, medical risks are considerably reduced, and patients are often quickly sent back to their homes to recuperate in a place where they feel most comfortable.

by Lawrence Goldstein, MD

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Oct/Nov 2009