Vascular Surgery

NewYork-Presbyterian Brooklyn Methodist Hospital

Vascular Surgery

Peripheral Artery Disease

With lower extremity peripheral arterial disease (PAD, also called peripheral vascular disease or PVD), there is a build-up of fatty "plaque" in the arteries of your abdomen, legs, or feet that reduces the flow of oxygen-rich blood through these vessels. PAD is most often caused by diabetes, obesity, high cholesterol, high blood pressure, and smoking. It's important for you to be treated for PAD early to prevent the need for amputation. At NewYork-Presbyterian Brooklyn Methodist Hospital, we understand this risk and work hard to avoid it by treating you quickly and effectively.

Care for Related Health Problems

Because many people with PAD often have atherosclerosis in other parts of the body, such as the heart or the blood vessels to the brain, we'll determine if you have other cardiovascular problems that need to be treated. As a major medical center, we can put together a team of specialists for you that includes all the doctors you need for your care, in one location. Vascular surgeons, wound care specialists, endocrinologists, and cardiologists are all available to you to meet your needs.

Specialized Care to Avoid Amputation

First, we'll try to treat your PAD with medication and lifestyle changes (such as recommending exercise and quitting smoking). If those therapies are not enough, we'll offer minimally invasive endovascular procedures to relieve the narrowing in your blood vessels and improve the supply of blood to your affected limbs. And if you need traditional surgery, our vascular surgeons have exceptional expertise to provide that care, too. Your care may include:

  • Balloon angioplasty. During angioplasty, we insert a deflated balloon-tipped catheter through an artery in your groin and guide it to the narrowed segment of your artery. When the catheter reaches the blockage, we inflate the balloon—compressing the plaque, widening your artery, and restoring blood flow.
  • Stenting. We may place a stent, a small metal scaffold, to "bridge" the site of the blockage during angioplasty. The stent is initially collapsed when we insert it into your body. Once the stent reaches the blockage, we expand it to conform to the wall of your artery, restoring blood flow. We leave the stent in place permanently to stay open and provide a reinforced channel through which blood can flow to your leg.
  • Atherectomy. We use a specially equipped catheter to remove plaque from the lining of your narrowed artery. We advance the atherectomy device through your artery to the site of your blockage, where we activate the device to shave off and remove plaque.
  • Conventional vascular surgery. If we cannot treat your PAD effectively using a minimally invasive approach, we'll offer you traditional vascular surgery. Examples include peripheral artery bypass surgery (rerouting blood flow as a detour around the blockage) or endarterectomy (surgically removing the plaque).

Peripheral Artery Disease

Peripheral Artery Disease or PAD is when the arteries in the legs become stiff or narrow due to plaque build-up and block the flow of blood and oxygen from the heart. PAD is sometimes called Leg Artery Disease and can cause discomfort anywhere in the legs between the hips down to the upper feet when walking. It may even lead to limb loss, heart attack or stroke.

Am I at Risk?

Peripheral Artery Disease is more likely to develop as you age, and the risk increases with the presence of diabetes, obesity, high blood pressure and high cholesterol. Living a healthy lifestyle is the best way to prevent the onset of PAD quit smoking, exercise by walking several times a week, eat a healthy diet and maintain an ideal body weight, manage diabetes and take measures to lower your blood pressure and cholesterol.

What are the Symptoms?

Patients with PAD may not feel any symptoms other than intermittent discomfort in legs that goes away when they stop walking. The discomfort could be tightness, heaviness, cramping or weakness that comes with activity. Advanced PAD may lead to critical limb ischemia, which is pain even when at rest, and in its most severe stages, PAD patients may develop painful sores on their toes and feet that could lead to gangrene.

How is it Diagnosed?

A routine physical exam which includes listening to the heartbeat, taking blood pressure and asking about medical history may indicate the potential presence of PAD. If you fall into a high-risk category, your doctor may take your pulse behind the knees or on the feet. If PAD is suspected, an Ankle-Brachial Index may be performed which compares the blood pressure in the arms and legs, and a cholesterol test may be recommended.

Further testing may be prescribed to better understand the extent of the PAD and your physician may choose from several procedures, including ultrasounds, non-invasive imaging tests (MRA), and CT scans or Angiography that use contrast dye to highlight the arteries. Angiography is typically used for patients with more severe PAD.

What is the Treatment?

How your NYPBMH physician treats PAD depends on the severity of the condition and ranges from lifestyle changes (ie - smoking cessation, exercise) to medications (ie to lower cholesterol or blood pressure) to surgery.

At NYPBMH, we perform the following procedures:

  • Angioplasty and Stenting this is a less invasive procedure where a surgeon inserts a long, thin tube called a catheter through a small puncture site in the groin. It is guided through the blood vessels and into the affected artery where it first takes a picture (angiogram) and then another catheter is inserted with a tiny balloon that inflates and deflates, flattening the plaque against the walls of the artery. Finally, a stent is inserted to hold the artery open.
  • Endarterectomy this is when a surgeon makes an incision and removes the plaque that has built up inside the inner lining of the artery
  • Bypass this is when a surgeon creates a detour around a blocked artery, allowing for free passage of blood and oxygen
  • Amputation this is a last-resort treatment done in only the most extreme cases of PAD.

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NewYork-Presbyterian Brooklyn Methodist Hospital

Vascular Surgery