PAD patients have a wide variety of treatment options
Patients often have misconceptions about treatments for peripheral artery disease (PAD) and critical limb ischemia (CLI) and rely or ignore care because they think their own option is open surgical procedures.
Cardiovascular Business spoke with Pedro Martinez Clark, MD, an interventional cardiologist and founder and medical director of Amavita Heart and Vascular Health in Miami. He set up PAD clinics to screen low-income patients in underserved Cuban and Haitian communities, where he hears patients talk about the fear of surgery.
"Back in the day, you needed to have this big peripheral artery bypass operation. And those operations are still very, very valid, important and they have a role in treatment. And vascular surgeons are extremely proficient at doing really complicated and complex bypass surgeries in the lower extremities. But, there are several options, and the vast majority of the first line of therapy for PAD is medical therapy and exercise," Clark explained.
He said the next step is usually a minimally invasive, out-patient cath lab procedure, rather than surgery. "These are nonsurgical procedures that are very safe and is ambulatory," he said.
Clark explained that the procedures can access arteries that are as small as 2.5 millimeters in size using ultrasound guidance with a little bit of sedation and a little bit of in local anesthesia.
"Through these small arteries in the feet, you can access a 2 millimeter vessel and open up a six millimeter artery. The devices that we have today are incredibly small in terms of the profile. So these procedures are really advanced and we can offer new revascularization options for these patients with very minimal risk.
Interventional operators also are very facile with new retrograde access route from the pedis artery in the foot or the popliteal artery in the lower leg.
He noted that a lot of interventional cardiologists are getting into the PAD space.
"From an operator perspective, if you want to get into this space, you really have to be proficient in all the percutaneous techniques and different access routes. From an interventional perspective, peripheral disease is a little different than coronaries, because in coronary procedures there's very little room for improvisation. But in PAD, you have a lot more room to try to figure things out and you can be more creative with the access points. But the fact that you are proficient in coronaries allows you to really deal with very small arteries, and that also gives you some tools and tricks that you can extrapolate to the revascularization arena," Clark explained.
Dave Fornell has covered healthcare for more than 17 years, with a focus in cardiology and radiology. Fornell is a 5-time winner of a Jesse H. Neal Award, the most prestigious editorial honors in the field of specialized journalism. The wins included best technical content, best use of social media and best COVID-19 coverage. Fornell was also a three-time Neal finalist for best range of work by a single author. He produces more than 100 editorial videos each year, most of them interviews with key opinion leaders in medicine. He also writes technical articles, covers key trends, conducts video hospital site visits, and is very involved with social media. E-mail: dfornell@innovatehealthcare.com