Peter Hibberd, M.D., is a doctor whose advice is based on more than 28 years of hospital outpatient and inpatient experience. He is an experienced emergency medicine physician, surgeon, and consultant. Dr. Hibberd is certified by the American Board of Emergency Medicine. He is also a fellow and active member of the American Academy of Family Physicians, an active member of the American College of Emergency Physicians, and a member and fellow of the American Academy of Emergency Medicine. Dr. Hibberd has earned numerous national and international professional certifications, memberships, and awards.
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Alternative to Surgery for PAD

Monday, 22 Jun 2009 03:51 PM

Question: Is there any alternative to angioplasty to treat peripheral artery disease? I have some kidney problems (not serious) and don't want to use dye. My vascular surgeon recommends angioplasty but I am wondering if there I some other way — ultrasound, radio waves or whatever!

Dr. Hibberd's Answer:

Peripheral artery disease, also called PAD, may be treated conservatively at first, often using combinations that change the flexibility of red blood cells, such as Trental and aspirin, often in association strategies to lower lipid levels. If untreated, PAD may place you at risk for limb loss.

You have several corrective options:
1. Medical noninvasive treatments with mild disease.
2. Surgical, with full invasive vascular bypass and grafting. This procedure requires full anesthesia, and usually uses synthetic grafting material.
3. Minimally invasive surgery with angioplasty and stenting. This uses a balloon dilation within the blood vessel. Sometimes the dilated area is supported with a metal mesh inserted inside the dilated segment to reduce recurrence. This is much less invasive than grafting and usually does not require general anesthesia.
4. Atherectomy (physical removal of plaque by a rotor type device), with or without stenting with angioplasty.

There are no effective therapies using external stimulation or heat radiation. It may be argued that these various therapies are useful in vascular disease, but only by encouraging temporary dilatation of vessels and improved circulation. They may add to the patient's comfort but are not treatments that will reverse disease.

Progressive disease can be arrested or slowed medically, but no other non invasive methods have been found to correct existing disease.

With renal disease, you will need to discuss the additional risks of various procedures and associated anesthesia risks. The secret to treatment is first-line prevention by avoiding smoking cigarettes and reducing risk factors for vascular disease (such as lipid disorders) as much as possible as early as possible. Using less invasive methods often will allow more invasive procedures later if necessary.


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