OakLeaf Medical Network Healthy Viewpoints, Winter 2003
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Anton Sharapov, MD, FRCS(C)

Surgical Options in Peripheral Vascular Disease

Anton Sharapov, MD, FRCS(C)
General Vascular and Endovascular Surgery, ABS Certified
Evergreen Surgical
Eau Claire

Peripheral vascular disease (PVD) is a common condition that affects virtually every vessel in the body. Vessels supplying the brain, heart and lower extremities are most commonly affected. PVD is one of several manifestations of atherosclerosis
a disease of the blood vessels associated with:

  • Elevated fat and cholesterol levels
  • High blood pressure
  • Diabetes
  • Smoking
  • Genetic factors 

Thickening and ulceration on the interior surface of the blood vessel leads to reduced blood supply, which eventually progresses to cessation of blood flow through the affected vessel. This may happen suddenly – when a blood clot forms on the ulcerated surface of the vessel wall or gradually, as a result of the thickening of the blood vessel wall.  In the end, that portion of the body supplied by the affected vessel will be at risk for damage, with devastating consequences – stroke, heart attack, or limb loss.

PVD affects virtually every vessel in the body.  In order to be successful in managing this condition, one can’t simply concentrate on the heart, leg, or brain blood vessels, but must address all at once. The disease process is gradual.  If detected early, treatment, including diet, medications to reduce blood clotting and fat and cholesterol level, blood pressure and diabetes management and lifestyle modifications may change the course of the disease and avert its consequences.

Most patients with claudication – crampy calves and thighs - can be treated with life style changes and medication. Sometimes the disease progresses to the point when more dramatic intervention may be required – such as in limb-threatening ischemia (a restriction in blood flow) or when symptoms prohibit a patient from working.

If aggressive treatment and exercise have failed to bring about desired results, the traditional course of treatment is open vascular bypass surgery. The obstructed portion of the circulation is bypassed with either a transplanted vein or artery to bring the blood flow to the affected organ.

However, open vascular bypass surgery does place certain stress on the body. The surgery:

  • May require general anesthetic
  • Takes a long time in the operating room
  • Produces scars
  • May have wound healing problems
  • Requires a long hospital stay
Most importantly, vascular bypass surgery is associated with one of the highest rates of heart attack, strokes and death compared with any other surgical procedures.

Research has shown that when open bypasses are done in hospitals with experienced vascular specialist teams including nurses, family doctors, anesthesiologists, cardiologists, internists and vascular surgeons – the overall rate of complications is acceptably low. One of the most exciting areas in vascular medicine has been the development of a minimally invasive alternative to open vascular bypasses.

Subintimal angioplasty (SIA) is one of several techniques at the disposal of the vascular specialist to restore the affected circulation.  Through careful manipulation of micro guide-wires, catheters and balloons, a new channel for blood flow is created in the existing vessel.

The entire procedure can be done in less than one hour, through a small 2-3 mm incision in the groin, under local anesthetic, with the patient going home the same day.

Most vascular specialists would agree that SIA does not provide equally effective and durable results compared to open bypass surgery. However, because angioplasty is minimally invasive, it is considered safer and creates minimal stress on the patient. It may be the best (and the only) option for someone who cannot tolerate an open procedure. Your vascular specialist is in the best position to decide whether this new option is right for you.

~ For more information or to schedule an appointment with Anton Sharapov, MD, Evergreen Surgical, Eau Claire, call 715.832.1044or visit www.evergreensurgical.com.