Angioplasty and Stenting for PAD: Procedure and Benefits

Peripheral Artery Disease (PAD) is a common but serious condition affecting millions of people in India. The prevalence of PAD is notably high, with studies revealing that it affects around 10-20% of adults aged 40 years and above. This rate increases significantly with age, particularly among those over 70 years old, as well as individuals with a history of diabetes or smoking.

PAD can cause significant discomfort and increase the risk of severe complications such as foot gangrene and diabetic foot ulcers. Timely intervention is crucial to prevent these outcomes, and one of the most effective treatments for PAD is the combination of angioplasty and stenting. Read on to learn how these procedures work and the benefits they offer to patients with PAD.

Understanding Peripheral Artery Disease (PAD)

PAD is a disease characterised by the narrowing or blockage of the arteries, particularly in the legs. This narrowing is typically caused by atherosclerosis, a process in which fatty deposits, or plaques, build up on the walls of the arteries. As these plaques grow, they reduce the space available for blood to flow, leading to lower oxygen and nutrients being supplied to the tissues in the legs. PAD can cause significant discomfort and increase the risk of severe complications such as foot gangrene and diabetic foot ulcers. If left untreated, it can cause tissue death and the need for amputation.

Several factors can increase the risk of developing PAD. Atherosclerosis is the primary cause, but other risk factors include:

• Diabetes: High blood sugar levels can injure blood vessels and lead to the development of plaques.
• Smoking: Consumption of tobacco is a major risk factor, as it injures the blood vessels and accelerates the build-up of plaques.
• Age: The risk of PAD increases with age, particularly after the age of 50.
• Hypertension: High blood pressure can injure the arteries, making them more susceptible to atherosclerosis.
• High Cholesterol: Elevated LDL (bad) cholesterol levels contribute to forming plaques in the arteries.
• Obesity: Excessive weight increases the strain on the cardiovascular system and contributes to other risk factors, such as diabetes and high cholesterol.

Symptoms of PAD

The symptoms of PAD can differ depending on the severity of the condition. In the early stages, many people may not experience any symptoms, but as the disease progresses, the following signs may become apparent:

• Claudication: Pain or cramping in the legs, particularly when walking or exercising, due to insufficient blood flow.
• Numbness or Weakness: A feeling of numbness or weakness in the legs, often worsening with activity.
• Coldness: The affected leg or foot can sometimes feel colder than the rest of the body due to reduced blood flow.
• Sores or Ulcers: Non-healing ulcers on the toes, feet, or legs are common, and if not treated promptly, they can lead to infections and gangrene.

Diagnosis of PAD

Diagnosis of PAD generally involves a combination of medical history, physical examination, and diagnostic tests. Common tests used to diagnose PAD include:

• Ankle-Brachial Index (ABI): An easy and non-invasive test that corresponds the blood pressure in the ankle with that of the blood pressure in the arm to detect any differences, indicating blocked arteries.
• Doppler Ultrasound: This imaging test utilises sound waves to form images of the blood flow in the arteries, helping to identify blockages or narrowing.
• Angiography: A more detailed test where a contrast dye is inserted into the arteries, and X-rays are taken to visualise the blood vessels and detect any abnormalities.
• Blood Tests: These tests measure cholesterol and glucose levels, which are critical in assessing the risk and progression of PAD.

Treatment Options for PAD

Once PAD is diagnosed, treatment focuses on managing symptoms, increasing quality of life, and preventing complications. Treatment options include:

• Lifestyle Changes: Adopting a healthier lifestyle is important in managing PAD. This includes quitting smoking, exercising regularly, and following a heart-healthy diet.
• Medications: Medications may be prescribed to decrease cholesterol levels, manage blood pressure, and improve blood flow. These can help reduce symptoms and slow the progression of the disease.
• Surgical Interventions: In more serious cases, surgical interventions may be required to restore blood flow. This can include bypass surgery or, more commonly, angioplasty and stenting.

Angioplasty and Stenting for PAD

Angioplasty and stenting are minimally invasive methods used to treat PAD.

What is Angioplasty?

Angioplasty is a minimally invasive method used to widen narrowed or blocked arteries. A narrow catheter tube is inserted into the affected artery during this procedure. The catheter has a small balloon on its tip, which is inflated to push the plaque against the artery walls, widening the artery and restoring blood flow. The balloon is then deflated and taken out, leaving the artery open.

Angioplasty is often recommended for patients with PAD who have not responded to lifestyle changes and medications or those at risk of developing complications such as foot gangrene or diabetic foot ulcers.

What is Stenting?

Stenting involves placing a small mesh tube, known as a stent, in the artery to keep it open after angioplasty. The stent acts as a scaffold, stopping the artery from narrowing again. There are two main types of stents:

• Bare-Metal Stents: These are simple metal stents that provide mechanical support to the artery.
• Drug-Eluting Stents: These stents are coated with slowly released medication to prevent the artery from becoming blocked again.

Stents are usually placed during or after angioplasty to maintain blood flow and reduce the risk of artery narrowing again.

How Angioplasty and Stenting Work Together

Angioplasty and stenting are often performed together as part of a comprehensive treatment plan for PAD. The combination of these procedures enhances treatment efficacy and patient outcomes. The process typically involves:

• Initial Diagnosis: PAD is diagnosed using tests such as ABI, Doppler ultrasound, or angiography.
• Angioplasty: The narrowed or blocked artery is widened using a balloon-tipped catheter.
• Stenting: A stent is placed in the artery to keep it open and ensure long-term blood flow.

This combination improves circulation, reduces symptoms, and prevents serious complications like foot gangrene and diabetic foot ulcers.

Benefits of These Procedures

Angioplasty and stenting offer several benefits for Patients with PAD, including:

• Minimally Invasive: These procedures are less invasive than open surgery, reducing recovery time and lowering risk" for better parallelism.
• Improved Blood Flow: patients experience immediate relief from symptoms and a significant decline in the risk of further arterial blockage.
• Reduction in Complications: These procedures help prevent severe complications, such as foot gangrene and diabetic foot ulcers, by restoring blood flow.
• Long-Term Success: Regular follow-ups with the healthcare provider, managing risk factors, and leading a healthy lifestyle are crucial to preventing recurrence.

Post-Procedure Care

Following angioplasty and stenting, proper post-procedure care is essential for a successful recovery. This includes:

• Immediate Aftercare: Patients should follow guidelines for monitoring their condition, taking prescribed medications, and making necessary lifestyle changes.
• Long-Term Care: Regular follow-ups with the healthcare provider, managing risk factors, and leading a healthful lifestyle are crucial to prevent recurrence.
• Warning Signs: Patients should be aware of symptoms that may indicate complications, like increased pain, swelling, or indications of infection, and seek medical attention promptly.

The Takeaways

Peripheral Artery Disease is a serious ailment that requires timely intervention to prevent severe complications such as foot gangrene and diabetic foot ulcers. Angioplasty and stenting are effective, minimally invasive treatments that can significantly improve circulation and reduce the risk of complications. Early diagnosis and treatment are necessary for managing PAD effectively.

Dr. Akhil Monga: Your Trusted Partner in PAD Care

If you're experiencing symptoms of PAD or are at risk of the condition, don't let it control your life. Dr Akhil Monga provides expert treatment for such conditions. Book an appointment with him today for a comprehensive evaluation and personalised treatment plan. He will help you regain mobility, reduce pain, and improve your life.