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Are You at Risk for PAD?

















Comprehensive Vascular Program

This department offers patients preventive, diagnostic, interventional and surgical treatment options. This is accomplished within a multidisciplinary framework of cardiologists, radiologists, interventionalists and surgeons working together to determine the best options for each patient. The program was expanded to accommodate the growing number of vascular patients coming to Deborah, and to raise awareness of the significant relationship between heart disease and vascular disease.

Benefits of Deborah's Comprehensive Vascular Program

Prompt, complete vascular diagnosis

State of the art interventions

Needs assessment for the patient

Early detection and appropriate treatment of
co-morbid conditions such as heart disease

Risk factor modification (treatment of blood pressure and cholesterol)

Long term medical guidance and care

A seamless approach to the treatment of vascular disease, with the participation of radiologists, cardiologists and vascular surgeons, forms the basis for a cohesive decision-making process that allows for the integrated delivery of vascular and cardiac care.

Deborah's Process of Care
Patients referred for a vascular condition will be evaluated by Physicians specializing in vascular care. The patient’s risk factors will be assessed and/or the stage of disease progression will be determined. Many patients can manage their disease with medication or diet and exercise programs. Some can be treated with interventional catheterization procedures. Numerous surgical options are available for patients who are not candidates for medical or interventional treatments. At times combined open/endovascular procedures can be offered to patients to minimize recovery time following the procedure. Deborah’s Comprehensive Vascular Program offers the confidence that a team of the region’s best specialists are working together to determine the most appropriate options for all patients.

Deborah's Era of Total Vascular Care
By combining the expertise of cardiologists, radiologists and vascular surgeons, the quality of vascular care provided to Deborah patients and the ability to identify patients at high cardiac risk will improve.

Prevention of atherosclerosis, lipid management, hypertension control, and modification of behavioral risk factors such as smoking, can be effectively managed simultaneously with diagnosis and treatment of the presenting problem.
This concept of care will result in better clinical outcomes not only for patients with vascular disease, but also for patients with heart disease. This new era of total vascular care will positively impact both lifestyle and health.

PAD is associated with significant cardiovascular morbidity and mortality, with a high rate of fatal and non-fatal cardiovascular events such as MI, stroke, and progressive ischemic end-organ dysfunction.
Since atherosclerosis is the most common cause of PAD, patients with PAD have a rate of cardiovascular mortality that is 3 to 5 times higher than age-matched controls. The cardiac mortality in symptomatic PAD is estimated to be 50% at 10 years. The reduction in quality of life from global vasculopathy in many patients can thus be significant.

Symptoms of Peripheral Arterial Disease
Recent studies suggest that only 11% of patients with confirmed diagnosis of PAD had symptoms of classic claudication. There is a large pool of data to suggest that up to 50% of patients with PAD experience no symptoms at all. The classic symptoms of claudication, or leg pain with ambulation, include: onset of pain with exertion, crampy, achy/burning sensation in the muscles of the calf or thigh, relief of pain with rest, and some measure of reproducibility of symptoms at specified distances on level ground.

How is Peripheral Arterial Disease Diagnosed?
The blood pressure in the pedal artery divided by the higher of two blood pressures in the brachial arteries, constitutes the ABI (Ankle Brachial Index), which is the basis for diagnosing and risk stratifying patients with peripheral vascular disease.

A normal ABI is >1.0

Mild PVD is characterized by an ABI of 0.80-0.99

Moderate PAD is characterized by an ABI of 0.50-0.79

In severe PAD, the resting ABI is usually less than 0.50

The test is simple to perform and has great prognostic value in the management of these patients.

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What is the Prognosis for Peripheral Arterial Disease?
The ABI has been demonstrated in many studies to be a powerful independent prognosticator of cardiovascular mortality in patients with PAD. Symptomatic PAD with and abnormal ABI carries a 30% 5-year mortality and 50% 10-year mortality from cardiovascular causes. Patients with asymptomatic PAD, characterized as an abnormal resting ABI, have a 2 to 5 fold higher risk of cardiovascular risk than age-matched patients with normal ABI studies.


70yr old woman experienced severe pain of the left leg when walking from her bedroom to her bathroom, a distance of 20 feet. Initial angiography (left) shows a complete occlusion of the left iliac artery (red arrows). Left iliac artery angioplasty and stent deployment (right, red arrows) was successful in restoring blood flow to the left leg. She is now able to walk 2 miles a day.


56yr old man confined to a wheelchair due to severe pain in both legs. Angiography (left) showed complete occlusion of both iliac arteries(red arrows). After staged iliac artery angioplasty and stent deployment to reconstruct his blocked iliac arteries, (right, red arrows) he is walking without pain.

Frontrunner and Crosser
Deborah’s interventional cardiologists are now using two new breakthrough technologies in the treatment of peripheral arterial disease (PAD). The Frontrunner and Crosser offer Deborah’s specialists two new tools in their PaD treatment arsenal.

PAD is a common syndrome affecting a large segment of the adult population. Blockages in the arteries of the limbs can cause burning pain, cramping, coldness, changes in skin color, rashes, or ulcers on the legs. Left untreated, PAD can be life-threatening, and can also lead to gangrene requiring limb amputation.

Frontrunner works like an excavator, cracking any blockage to create a channel to facilitate angioplasty and save the limb. This tool proves to be especially helpful when a patient has a chronic total occlusion (blockage) in an artery. Previous tools may have led to bypass surgery or amputation.


Crosser, similar to a jackhammer, uses high-frequency vibration allowing the catheter navigation across chronic total occlusions (blockages) in arteries. This also helps patients to avoid undergoing more invasive surgery. Over the past years, specialists at Deborah have been able to diagnose and treat PAD with minimally-invasive techniques that are catheter-based, avoiding the complications and prolonged recovery required with surgery.

These two new devices greatly increase Deborah’s specialists’ range of activity and expand the range of treatment options for patients. Deborah is one of the few hospitals in the region that utilizes these new devices in its endovascular division along with other cutting edge technology.

TAPAS™ Catheter
The TAPAS Catheter is designed for use in peripheral vascular disease treatment. It is an innovative system with two compliant occlusion balloons that can deliver a controlled therapeutic, or diagnostic, agent and dose. This therapeutic infusion system has an adjustable length, so that long vessels can be treated with one device. It also offers the capability of extracting the medicine out of the vascular treatment zone if necessary, so there is no drug run-off during a localized intravascular treatment. The TAPAS Catheter can be used in conjunction with other interventional devices.