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Home > Procedures > Inverventional Radiology Procedures: Peripheral Vascular Disease (PVD)

Peripheral Vascular Disease (PVD)

About PVD

Peripheral Vascular Disease (PVD) involves narrowing of a patient’s arteries--most often in the lower extremities--that results in decreased blood flow to the feet. This occurs due to build

There are approximately 12 million patients in the US with PVD of which only 2.5 million are diagnosed.  Despite its significant prevalence, very few patients--a total of less than 5 %-- are treated interventionally.

At Valley Imaging, we feel strongly in developing a multidisciplinary approach to develop effective screening methods and then determine which patients require therapeutic intervention.

Signs and Symptoms

PVD presents initially with “claudication” (exertional leg pain).  As the disease progresses, pain occurs at rest, often at night during sleep.  Worsening disease then results in ulceration in the lower legs and feet, and in its most severe form, gangrenous changes of the toes.   Leaving the disease unchecked often results in osteomyelitis and inevitable amputation. 

Screening Patients

Smoking and diabetes are strong risk factors for PVD.  For that reason, any smoker or diabetic with foot or leg pain should be worked up for PVD.   Additionally, all people over 70 with leg pain should also be screened.
There is a high degree of correlation between coronary artery disease and PVD as well.  Any patients with coronary artery disease that present with lower extremity pain should be further evaluated.

Diagnostic Evaluation

The simplest, quickest, and most inexpensive screening method is the ABI (ankle brachial index).  This measures the arterial pressure ratio of the lower extremities in relation to the upper extremities. Values below 0.9 suggest PVD.

Further workup can be performed with an arterial duplex study.  Doppler velocities and waveforms of the blood flow are studied to indicate focal areas of occlusion or stenosis.

The most advanced non-interventional workup consists of an MRA (magnetic resonance angiogram) or a CTA (CT angiogram).  This provides highly detailed anatomy of the patient’s arterial circulation and often aids in planning further intervention.

The angiogram is the gold standard for evaluation arterial circulation.  Given the excellent non-interventional tools available, this is often performed in conjunction with a planned intervention.

PVD - Diagnostic EvaluationCT AngiogramMagnetic Resonance angiogram

Therapeutic Interventions

Atherectomy DeviceAt Valley Imaging, we have three highly trained interventional radiologists that use the newest techniques in peripheral arterial revascularization. After candidates are carefully worked up and selected for intervention, a diagnostic angiogram is initially performed to identify areas requiring treatment. Our IR physicians then choose from an wide variety of methods to repair the artery. Depending on the size and characteristics of the stenosis or occlusion, an atherectomy can be performed. This involves using a special device with a spinning blade to cut and remove the plaque from the artery. The process is repeated until vascular flow is optimally restored.
In some cases, an angioplasty is preferred. In many of these situations, a cryoplasty procedure is performed which involves inflating a balloon in the narrowed segment of the vessel and then freezing the balloon. In theory, many of the cells involved in building up the plaque are killed.

In addition to the above procedures, conventional angioplasty is frequently performed.

Many cases require stenting, and this is most often performed in the renal, celiac, superior mesenteric, and iliac arteries.

Follow-up Care

Most of our patients are admitted overnight for observation. We closely follow our patients with serial ABI's to document restored vascular flow. We follow our patients over multiple clinic visits to assess recurrence of disease so that it may be re-treated as necessary.

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