Diseased Legs Can Be Saved Through Stenting

Andrew Feiring, M.D., Interventional Cardiologist, Columbia St. Mary’s

Posted: Feb. 1, 2007

Peripheral vascular disease is the number one cause of leg amputations in the United States. In fact, approximately 150,000 leg amputations are performed annually due to advanced vascular disease of the legs. That is why peripheral vascular disease (PVD) needs to be taken seriously and treated early, before it results in the loss of a limb.

A person who has a family history of vascular disease, smokes, has diabetes, high cholesterol or high blood pressure is at risk for developing vascular disease. And because it is difficult to predict how quickly the disease will progress, persistent leg pain or life-altering claudication (discomfort that occurs in the calf or thigh with walking and relieved with rest) should be evaluated as soon as possible by your physician. Left unchecked, PVD can lead to one leg amputation, with a 33 percent chance of a second leg amputation becoming necessary.

The good news is there are many treatment options – even in advanced stages of the disease – that can help manage vascular disease and ultimately save a patient’s limbs. According to my research, as well as European medical data, the most effective treatment options for severely blocked arteries below the knee is artery stenting.

Stenting for vascular disease has been available for nearly a decade and is quickly becoming the gold standard in care for patients with advanced vascular disease above the knee. Inserting a stent is a minimally invasive operational procedure in which angioplasty is performed and a stent is put into place. Angioplasty opens the artery using a tiny balloon attached to a catheter and the stent – a small, wire mesh tube – is inserted into the blocked artery permanently. This treatment combination allows the artery to heal in an open position, keeping the blood flowing to the lower leg.

My research has demonstrated that stenting a leg artery below the knee with drug coated sents decreases the chances of artery reblockage, from 50 percent down to only 6 percent.

Leg artery stenting is typically considered for people who have pain in the foot while at rest (meaning the PVD is in an advanced state) or skin ulcerations. This can only be accomplished if a small wire can be passed through the blocked artery to allow for stenting.

If leg stenting is performed before skin ulcerations occur, it leads to leg salvation 95 percent of the time. In addition, one year post-surgery the vast majority of patients – 95 percent – experience significant pain relief and tissue healing. This procedure, which can be performed as an outpatient through a small 1/5th-inch groin artery puncture, has minimal risk. This is in comparison to current standard surgical therapy that has a 5 percent mortality and requires prolonged hospitalization.

The ultimate goal in PVD treatment is to restore the blood flow back to the legs. With progressive PVD, surgical procedures such as stenting may be necessary. Often, however, depending on how advanced the disease is, medication and lifestyle modifications are employed. Weight loss, lowering your blood pressure or cholesterol, and smoking cessation can all be perfectly effective means of stopping the progression of PVD.

Angioplasty without stenting and artery bypass surgery are two other treatment options, however, for vascular blockages that occur below the knee, inserting a drug-coated stent can often be the most effective long-term solution for managing PVD.

Endovascular medicine (treating the arterial blockage without surgery) is a relatively new discipline. The more we learn about the disease and how it advances, the better able we are to tailor a treatment plan to each patient with the goal of ending leg pain and saving the leg.

Andrew Feiring, M.D., FACC, FSCAI
Interventional Cardiologist
Columbia St. Mary’s
414-961-VASC

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