Vascular interventional cardiologist Andrew Feiring, MD, is at the forefront in the non-surgical treatment of peripheral vascular disease at Columbia St. Mary’s. Dr. Feiring, Director of the Cardiac and Catheterization Labs, is saving limbs and lives by using newer interventional procedures to treat his patients, who range in age from 35 to 103.
Peripheral artery disease or PAD (also called peripheral vascular disease or PVD) is a serious disorder that results from a buildup of plaque in the peripheral arteries (those away from the heart), most commonly in the pelvis, legs, and arteries in the neck. The plaque narrows the inside of the vessels, constricting blood flow.
“A buildup of plaque in peripheral vessels is an indication of a buildup in vessels throughout the body,” Dr. Feiring said. “Left untreated, PAD may result in amputation, heart attack, stroke, renal failure, and death.”
Symptoms include pain when walking and a foot ulcer or sore that does not heal. Some people may not have significant symptoms. Risk factors for PAD are the same as for heart disease: smoking, diabetes, high blood pressure, high cholesterol level, and family history of vascular disease. The disease affects up to 12 million people in the United States.
The earlier the disease is detected and treated, the better the outcome and the lower the risk for heart attack, stroke, and leg amputation. While PAD can be treated with diet, exercise, and some medications, a procedure to open the blocked arteries is the only way to restore normal blood flow. The good news is that blocked leg arteries often can be opened using newer non-surgical methods.
Dr. Feiring has had great success using the following treatments for PAD:
Leg stents—Stents, tiny steel mesh tubes, were first used to prop open blocked heart arteries. The stent is threaded into a blocked artery as part of an angioplasty procedure. Once in the artery, the stent is expanded to increase the diameter of the vessel and improve the blood flow to the heart.
In the last few years, Dr. Feiring has pioneered the use of stents below the knee. He has the most extensive limb salvation experience in Wisconsin (performing more than 150 leg stenting procedures), and leads one of only 10-15 limb stenting programs in the country. Leg stents, inserted into a leg artery through a catheter, are particularly effective for opening blocked vessels below the knee and greatly reduce the need for amputation, Dr. Feiring said.
Silverhawk device—More than 1½ year ago, Dr. Feiring was the first physician in the Milwaukee area to use this new device that actually slices away plaque from within a narrowed artery. He has the largest experience using this device, which consists of a thin, flexible tube with a tiny rotating blade that is inserted into a blood vessel. The blade spins, cutting into the plaque without stretching the vessel. The plaque is stored in a collection chamber in the tube and removed when the device is taken out.
“It's like a cheese grater, shaving off small pieces of plague as it moves through the artery,” Dr. Feiring said. “We watch the device under a fluoroscope as it moves through the vessel.”
Dr. Feiring said that this device appears to do a better job than stents to open arteries in the knee and the lower part of the thigh. He has performed about 75 procedures with the device with good results.
Balloon Angioplasty—In this procedure, a thin flexible tube (catheter) is inserted through an artery and guided to the place where the artery is narrowed. Once the tube reaches the narrowed artery, a small balloon at the end of the tube is inflated. The pressure from the inflated balloon presses the plaque against the wall of the artery to improve blood flow.
“These treatments relieve symptoms, increase independence, and prevent leg amputations and, in conjunction with aggressive risk-factor modification (i.e. cholesterol, smoking, hypertension, and diabetes management), greatly reduce the risk of heart and vascular catastrophic events,” Dr. Feiring said. “Each is a tool for improving blood flow, and the choice of which one(s) to use varies with each patient.”