Peripheral Vascular Interventions

The same technologies utilized in the management of coronary atherosclerotic heart disease have now been applied to the management of peripheral vascular disease. Angioplasty, stents, atherectomy (removal of plaque) and bypass surgery are now widely used in the management of this disease. In addition, the routine use of anti-platelet agents (Aspirin and Clopidogrel) and lipid-lowering medications as well as risk factor modification (smoking cessation, management of high blood pressure, etc.) are standard treatments.

Most patients undergo non-invasive peripheral vascular testing first. If deemed appropriate, an angiogram of the abdominal aorta and lower extremities is performed to provide detailed anatomical information for an individual patient.

Same lesion following SilverHawk atherectomy.

Following the diagnostic angiogram, a discussion is generally held with the patient and Dr. Paustian regarding the various treatment options including surgery and endovascular therapies. The use of angioplasty, stents and atherectomy is known as "endovascular therapy." The specific type of therapy chosen is dependent upon multiple factors including co-morbities, anatomical factors and patient preference.

Endovascular procedures are generally performed on an outpatient basis at the hospital similar to cardiac catheterization procedures by Dr. Paustian. Surgical interventions require referal to a vascular surgical specialist.

Plaque removed with SilverHawk atherectomy device

Many individuals wonder what happens to the plaque during these treatments. In most angioplasty and stent cases, the plaque is crushed into the wall of the blood vessel. It is possible for debris to break loose during these procedures, especially with the SilverHawk atherectomy procedures where plaque is literally cut-off and removed from the inside of the blood vessel. The atherectomy device itself has a small reservoir in its tip to capture the cuttings. In addition, a special miniturized "fish net" known as a filter wire is placed downstream from the treated area to capture debris as shown in some of the photographs.

Follow-up after these procedures is performed in the office setting.

Debris trapped in filer wire following procedure.

News Media Articles

See the Helena Independent Record newspaper article on this procedure by clicking here.

See the ABC TV news article here.

See the CBS TV news article here.

See the Billings Gazette article here.

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