ArtAssistDevice - Sherif Sultan

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Angioplasty

This is the gold standard and first-line treatment for patients requiring intervention. This ‘keyhole technique’ involves insertion of a catheter with a small balloon on the tip into the artery to widen the passageway. Sometimes a stent (small metal frame) maybe placed inside the artery to hold the walls open. The surgeon guides the balloon by watching an image of your artery on a video monitor.

If there are no complications it may be possible to go home on the same day!

Bypass Surgery

If your symptoms are getting worse and the blockage cannot be treated with angioplasty then open bypass surgery may be needed. This surgery, which requires a hospital stay, can treat blocked arteries in the abdomen or the leg. The surgeon uses a graft, either a vein from your own leg or a synthetic (man-made) tube, to create a path around the artery blockage.

Protection of your Graft.

If you have an open or endovascular graft in place, inform the relevant doctor if you are having further surgery or any invasive procedure, such as an angiogram. You may need ‘prophylactic’ antibiotics to protect your graft from infection.

References

Sultan S, Hynes N. Cardiovascular disease: primary prevention, disease modulation and regenerative therapy. Vascular. 2012 Oct;20(5):243-50. PMID:23019607

Sultan S, Tawfick W, Hynes N. Cool Excimer Laser-Assisted Angioplasty vs Tibial Balloon Angioplasty in Management of Infragenicular Tibial Arterial Occlusion in Critical Lower Limb Ischemia TASC D. Vascular Disease Management. 2011 Nov; 8:E187–E197

Sultan S, Hynes N. Mid-Term Results of Subintimal Angioplasty for Critical Limb Ischemia: 5-Year Outcomes. Vascular Disease Management. 2011 Sept;8:E155–E163

Sultan S, Hynes N. Five-Year Irish Trial of CLI Patients With TASC II Type C/D Lesions Undergoing Subintimal Angioplasty or Bypass Surgery Based on Plaque Echolucency. J Endovasc Ther 2009 Jun;16(3):270-283. PMID: 19642779

Sultan S Non-operative active management of critical limb ischaemia:initial experience using a sequential compression biomechanical device for limb salvage. Vascular 2008 16(3):130-9

Sultan et al. A prospective feasibility study of duplex ultrasound arterial mapping, digital subtraction angiography and magnetic resonance angiography in the management of critical limb ischaemia by endovascular revascularisation Ann Vasc Surg 2007 21(4)

Scheinert D, Peeters P, Bosiers M, O'Sullivan G, Sultan S, Gershony G. Results of the multicenter first-in-man study of a novel scoring balloon catheter for the treatment of infra-popliteal peripheral arterial disease. Catheter Cardiovasc Interv. 2007 Dec 1;70(7):1034-9. PMID: 18044759

Sultan S, Hynes N. Recent trends in the management of peripheral vascular disease in high risk patients. Heart Wise. 2007: 10(2);21-25.

Hynes N, Sultan S. Reinforced long saphenous vein bypass graft for infrainguinal reconstruction procedures: case series and literature review. Vascular. 2006 Mar-Apr;14(2):113-8. PMID: 16956481

O'Sullivan CJ, Hynes N, Sultan S. Haemoglobin A1C (HbA1C) in Non-diabetic and Diabetic Vascular Patients. Is HbA1C an Independent Risk Factor and Predictor of Adverse Outcome? Eur J Vasc Endovasc Surg. 2006 Aug;32(2):188-97.;PMID: 16580235

Hynes N, Sultan S. The influence of subintimal angioplasty on level of amputation and limb salvage rates in lower limb critical ischaemia: a 15-year experience. Eur J Vasc Endovasc Surg. 2005 Sep;30(3):291-9. PMID: 15939635

Hynes N, Sultan S. Subintimal angioplasty as a primary modality in the management of critical limb ischemia: comparison to bypass grafting for aortoiliac and femoropopliteal occlusive disease. J Endovasc Ther 2004 Aug;11(4):460-71. PMID: 15298498

Mr Sherif Sultan, MB BCh MCh MD FRCSI DEVS FISVS FASA DMD FRCS EBQS-VASC FACS

Depart of Vascular & Endovascular Surgery

Galway Clinic, Doughiska, Galway

Phone: +353 91 720122

Fax: 353 91 542360

E-mail: vascularsultan@

vascular.ie

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Peripheral Arterial Disease

A Guide for Patients

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What is peripheral arterial disease?

Your arteries deliver oxygen-rich blood from your heart to other parts of your body. Your peripheral arteries carry blood away from the heart to your arms and legs. The peripheral arteries in your legs are extensions of the largest artery in your body, the aorta. The aorta travels down through your abdominal region and branches off into the iliac arteries of each leg. The iliac arteries further divide into smaller arteries and deliver blood down your legs to your toes.

Healthy peripheral arteries are smooth and unobstructed, allowing blood to flow freely to the legs and provide oxygen, glucose, and other nutrients that your legs need. Typically with age, the peripheral arteries build up plaque, a sticky substance made up mostly of fat and cholesterol. Plaque narrows the passageway within the arteries and causes them to become stiff. Peripheral arterial disease results when the peripheral arteries become too narrow or obstructed and limit the blood flow to the legs. If left untreated, peripheral arterial disease can cause pain or aching in the legs, difficulty with walking, resting pain in the foot at night in bed, non-healing sores or infections in the toes or feet, and can lead to limb loss in its most severe form. In addition, it can be associated with other serious arterial conditions leading to heart attacks and stroke.

Causes and Risk factors

» Age

» Gender—males are more prone to the condition than females

» Hypertension (high blood pressure)

» Diabetes

» Smoking

» High cholesterol

» Obesity

» Lack of exercise

» Family history of vascular problems

Reducing Risk Factors

• Stop Smoking

• Low Fat Diet

• Control High Blood Pressure

• Care for your Feet

• Exercise Daily

Symptoms

There may be no symptoms in the early stages of peripheral arterial disease. Developing symptoms may include discomfort or pain in your legs when walking but no pain when you rest.

Diagnosis

Diagnosis of vascular disease begins with a careful medical history, including risk factors and physical exam, followed by non invasive tesing.

Non-Invasive Testing: Non-invasive testing uses state of the art ultrasound technology to evaluate flow, perfusion and pressures within the vessels at rest and with exercise. These procedures are painless (no needles are involved) and can help to determine if blood vessel disease is present, the location, and severity. Exclusively from the results of these tests, the surgeon will determine the need for more invasive testing or procedures to treat vascular disease.1

Treatment

Vascular surgeons are the only physicians who can perform all the treatment options available, including medical management, minimally invasive endovascular angioplasty and stent procedures, and open bypass surgery. Only when you see a vascular surgeon who offers all treatment modalities will you be assured of receiving the care that is most appropriate to your condition.

Medical treatment

All patients with peripheral vascular disease require a combination of medications. These thin the blood, reduce the build-up of plaque lower blood pressure and therefore promote optimal blood flow. Patients with mild disease, called claudication, can be treated with medication, reduction of risk factors and exercise alone.

ArtAssist Device

The Art Assist device is an ‘external pneumatic compression device’, i.e. a device that massages your foot, ankle and calf to improve your circulation. It has been shown to triple blood flow, and in so doing, dramatically increases pain-free walking distance, heals diabetic and non-diabetic arterial ulcers, and saves limbs in cases unsuitable for endovascular therapy or surgery.2 This is a mobile device that you can use in the comfort of your own home.

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