A recognition ceremony honoring January DAISY Award recipient, Debbie Houchin RN, General Med/Surgery at Methodist Hospital was held on Wednesday, Jan. 18.Methodist Health System Services
Interventional Radiology: Peripheral Vascular Disease
Peripheral Vascular Disease
Peripheral vascular disease is a broad spectrum of diseases with many different presentations. One of the most common symptoms is cramping of the calves, thighs, hips, buttocks or upper extremities with exercise that is relieved by rest (claudication). Other presentations include non-healing foot or finger ulcers. Blockages of arteries to the brain can also occur. This can present as transient episodes of extremity numbness and weakness, slurred speech, dizziness, visual disturbances as well as stroke. Blockage of arteries to the intestines can result in severe pain after eating and weight loss.
Pre-Procedure Work Up
Because this is such a broad spectrum of disease, peripheral vascular disease often requires workup customized to the individual patient. As experts in non-invasive imaging, our doctors can select appropriate tests for each individual patient. An accurate diagnosis can usually be made noninvasively with doppler ultrasound and CT or MR angiography. Patients selected for conventional arteriography are only those in whom a noninvasive diagnosis cannot be made or those whom we intend to treat with angioplasty. Our doctors' reimbursement is only minimally related to the number of procedures they perform and they have essentially no financial incentive to perform unnecessary procedures. When they do perform an invasive procedure, however, you can be sure you have an expert competent with techniques and instruments at the true cutting edge of the field.
Potential Risks
Prior to angiography or angioplasty, we discuss in detail with the patient potential risks and alternatives to the procedure. Risks include (but are not limited to) serious bleeding, infection, kidney failure, stroke and heart attack. The incidence of serious complications secondary to angioplasty is approximately 1%. If diagnostic angiography alone is performed without angioplasty the risk is approximately 0.1%. Patients treated with angioplasty have a 20-50% (depending on which artery was treated) risk of developing recurrent blockage over the subsequent 5 years.
Day of Procedure
On the day of the procedure, the patient is admitted through our access center and is taken to the pre-operative holding area. Intravenous fluids are administered and standard blood tests are performed if not done in clinic. The procedure is performed in an operating room with special x-ray imaging equipment. Local anesthesia and light sedation are administered. A catheter is advanced through the artery in the groin then into the diseased arteries. Iodine contrast is then injected and x-rays performed. If this confirms presence of a blockage in the artery then we proceed directly to angioplasty. If there is still a blockage after dilation with the balloon, we may place a metallic stent in the artery to help hold it open. Throughout the procedure the patient's family is informed of the progress of the procedure by our nurse liaison.
Post Procedure
Most patients can be dismissed from the hospital the following day. If angiography alone is performed the patient can be dismissed the same day. Activity is limited to no heavy lifting or strenuous activities for 7 days following angioplasty. Patients may go up and down stairs. They may drive the day following the procedure. Follow-up is by phone, clinic visit or follow-up with the referring physician depending on circumstances. We arrange follow-up screening tests and additional consultations to smoking cessation clinic or other indicated services.
