January 05, 2019
Peripheral Vascular Disorders

Blood vessels are the channels through which blood is carried to different parts of the body for utilization of oxygen, transport of proteins, hormones and waste products. These channels are the roadways to the heart, namely arteries, veins and capillaries. Arteries carry oxygenated blood from the heart to various parts of the body; veins carry blood from tissues and organs to the heart, and capillaries are the connecting channels between the arteries and veins. Without smooth flow in these channels, body cannot receive adequate oxygen and function optimally. Most diseases of vascular system create a road-block leading to an obstructed blood flow to various parts. Diseases affecting these vascular channels are vasculopathies. Ageing, Diabetes, hypertension, obesity, smoking lead to narrowing of the channels by causing deposition of fatty plaques, or damaging the walls of the channels of mostly heart, legs, neck and the brain.

Some other well known diseases affecting the vascular pathways are Buerger’s Disease, Bechet’s Disease, Giant Cell Arteritis, Polyangiitis and Polyarteritis Nodosa. Interventional radiology and vascular surgery teams deal with these diseases affecting the circulation system of arteries, veins and lymphatics. With early intervention, these diseases can be controlled from yielding sequelae/complications like amputation or even death in most cases.

Commonly, Intervention radiologists treat Varicose Veins, Peripheral Artery Diseases, Carotid Narrowing, Thoracic Compression Syndrome, Deep Vein Thrombosis, Spider Veins, Venous and Diabetic Ulcers, maturation of fistulas for dialysis access & similar diseases via endovascular route.

Methods employed in Interventional Radiology:

  • Ablation –destruction of abnormal tissues such as small growths, tumour etc
  • Angioplasty – dilating a narrowed vessel in case of arterial stenosis
  • Stenting – inserting a stent to prevent collapse of a vessel
  • Compression Therapies –pressure generated by the compression therapy promotes circulation within the tissue leading to increased oxygen supply. This method is employed in early varicose veins and venous ulcer as an adjunctive or first line measure.
  • Sclerotherapy – A microinjection containing solution which when inserted into small veins will destroy it, promoting new channel for the blood to drain into. This is the preferred treatment of choice for spider veins and small varicose veins.
  • Thrombolysis – Insertion of solutions which dissolve clots in the limb vessels and the brain, which when done within the golden hour will be life-saving.
  • Bypass grafting in peripheral arterial disease to restore blood flow is done by vascular or cardiothoracic surgeon if interventional therapy is not feasible or fails.

Other than the traditional surgeries, an interventional radiologist is proficient in accessing any part of the body through a vascular pathway. An interventional radiologist can efficiently gain access to the deepest parts of the body and perform angioplasty or stenting, prevent an aneurysm from bursting by aneurysm coiling and much more. Current advances in medicine and research towards non-invasive or minimally invasive intervention have put interventional radiology in the limelight. With continued research, this field of surgery will open to a wide range of aspects simplifying complex, minimally invasive, key-hole interventions. Benefits of this approach are innumerable, primarily reduced chances of infection, least blood loss, reduced hospital stay, cosmetic benefit, early mobility, recovery and return to normal lifestyle.