Vascular Imaging
To diagnose PAD accurately, our cardiac specialists perform noninvasive tests that use inflatable cuffs similar to those that measure blood pressure. We can do these tests during a regular office visit and they include:
Ankle-brachial index (ABI), a test that measures blood pressure at the ankle and in the arm to determine the severity of PAD.
Pulse volume recording (PVR), a noninvasive technique developed and introduced by clinicians at Massachusetts General Hospital to measure the blood flow in the upper and lower extremities.
Duplex ultrasound, which uses sound waves to evaluate blood flow.
Computed tomography angiography (CTA), where dye injected into the vein allows the care team to see detailed images of blood vessels and tissue.
Magnetic resonance angiography (MRA), a type of MRI that provides images of blood vessels.
Treatments
Medical therapy: Medications reduce the cardiovascular risk and/or symptoms associated with PAD. These important therapies control blood pressure, cholesterol and diabetes, and block platelet activity (blood clotting). Novel therapies under investigation at Mass General may be considered where appropriate to reduce symptoms or risk associated with PAD.
Smoking cessation: While preventive care is essential, our vascular specialists guide you through smoking cessation and other lifestyle changes.
Exercise therapy: This approach helps you walk farther without pain and enjoy the benefits of greater cardiovascular fitness. Exercise sessions involve walking on a treadmill and performing other lower-body training exercises.
Endovascular therapies: These minimally invasive treatments offer an alternative to conventional surgery, do not require an incision in the skin and typically offer a shorter recovery time. By inserting narrow plastic tubes, or catheters, into the blood vessels, our specialists access and open sites with cholesterol plaque blockage through a variety of techniques:
Angioplasty: A balloon-tipped catheter is placed into the artery and advanced to the obstructed area. The balloon is inflated to expand the blockage, and then deflated and retrieved, widening the narrowed artery.
Stenting: Often performed during angioplasty, this technique inserts a mesh-like device at the point of the cholesterol blockage. The device expands permanently into the vessel wall, propping open the blockage.
Atherectomy: We advance a specialized catheter with directable cutting blades, laser tip or polishing drill through the cholesterol plaque repeatedly, removing debris from the vessel wall to restore blood flow.
Surgical techniques such as:
- Endarterectomy: Through a surgical incision, we expose and open the blocked artery. We then remove plaque, widening the blocked artery.
- Surgical bypass: Blood flow is rerouted around the blocked blood vessel by attaching a conduit (either a vein harvested from the body or a prosthetic tube) above and below the point of obstruction.
