Peripheral Arterial Disease

Treating PAD with Interventional Radiology

The procedures that our doctors use to treat PAD are part of a medical specialty called Interventional Radiology (IR). This refers to the use of radiological image guidance to precisely target and treat a range of medical conditions and diseases.

Interventional radiologists are doctors who are specially trained to do minimally invasive vascular procedures, such as angioplasty and embolization, to treat a variety of conditions. Because many IR procedures start with passing a needle through the skin to the target, it's often called "pinhole surgery."

When treating PAD, each patient is evaluated, and the treatment approach is individualized for the patient's circumstances. The next section discusses three treatment options for PAD.

Minimally Invasive IR Treatments for PAD

Peripheral Vascular Disease (PVD) is a peripheral circulation disorder that affect blood vessels outside the heart and brain. PVD that develops only in the arteries is called Peripheral Arterial Disease (PAD). PAD develops most commonly as a result of atherosclerosis, or hardening of the arteries, which occurs when cholesterol and scar tissue build up, forming a substance called plaque inside the arteries. This is a very serious condition. The clogged arteries cause decreased blood flow to the arms, or more commonly, the legs. This can result in pain when walking and eventually gangrene and/or amputation.

Signs and Symptoms of PAD & PVD:

The most common symptom of PAD and arterial insufficiency is called intermittent claudication, which is painful cramping in the leg or hip that occurs when walking or exercising and typically disappears when the person stops the activity.

Other symptoms include: numbness, tingling and weakness in the lower legs and feet, burning or aching pain in feet or toes when resting, sore or wound on the leg or foot that won’t heal or is slow to heal, cold legs or feet, color changes in skin of legs or feet, hair loss on legs, pain in the legs or feet that wakes you up at night or pain at rest.

All of these symptoms can be indicative of poor circulation in lower extremity arteries.

PVD that develops in the deep veins in the body is usually caused from claudication and is called Deep Vein Thrombosis (DVT).

The causes of Peripheral Artery Disease

Peripheral artery disease is caused by a blockage in the arteries of the leg or arm. Our arteries are like hollow tubes through which blood flows. These tubes are smooth and stretchy.

As a result of predisposed risk factors and lifestyle choices, fatty deposits can attach themselves to the inside walls of blood vessels. Once fatty deposits start to stick, they build up. The body attempts to heal itself from the fatty buildup by making the vessel walls sticky.

This healing response allows other substances in the bloodstream, including calcium, proteins, and inflammatory cells, to become stuck. Together with the fatty deposits, this debris forms a plaque that narrows the artery.

Angioplasty:

Uses imaging guidance to insert a catheter (thin tube) into a blocked or narrowed artery. The catheter has a tiny balloon on its tip that is inflated to push plaque against the artery's walls to widen the path for blood flow.

Stenting:

Uses imaging guidance to direct a balloon catheter, and then a stent, to the site of the blockage. The balloon is inflated to open the blockage, and then deflated and taken out, leaving the stent in place to keep the artery open.

Atherectomy:

Uses imaging guidance and a catheter specially designed to remove plaque and collect it in a chamber in the tip. This allows removal of the plaque as the device is removed from the artery. Atherectomy may be used alone or in combination with balloon angioplasty to facilitate the placement of stents.

Frequently Asked Questions

What Happens During The Aquablation Procedure?

Aquablation therapy is performed in a hospital. You will be under anesthesia for the entire procedure. The procedure typically takes less than an hour and involves an overnight stay. There are two key steps to the procedure—creating a surgical map and removing the prostate tissue.
What Happens Immediately After The Aquablation Therapy?

As with most BPH procedures, you will wake up with a catheter following Aquablation therapy, which allows you to urinate while your urethra heals. Patients typically stay overnight in the hospital. While no one likes staying overnight in a hospital, the benefit with Aquablation therapy is that most patients end up leaving the hospital without a catheter.1,2,3 References: 1. Gilling, P, et al. Three-Year Outcomes after Aquablation Therapy Compared to TURP: Results from a Blinded Randomized Trial. Can J Urol. 2020 Feb;27(1):10072-10079. 2. Bhojani, N, et al. Aquablation for Benign Prostatic Hyperplasia in Large Prostates (80-150 cc): 1-Year Results. Urology. 2019 Jul;129:1-7. 3. Data on file at PROCEPT BioRobotics.
What Is Recovery Like After Aquablation Therapy?

As with most BPH procedures, you will wake up with a catheter following Aquablation therapy, which allows you to urinate while your urethra heals. Patients typically stay overnight in the hospital. While no one likes staying overnight in a hospital, the benefit with Aquablation therapy is that most patients end up leaving the hospital without a catheter.1,2,3 Once you’re home, you may experience mild burning during urination for a couple of weeks. This can be managed with mild pain medication. Patients can resume their normal activities once approved by their doctor. References: 1. Gilling, P, et al. Three-Year Outcomes after Aquablation Therapy Compared to TURP: Results from a Blinded Randomized Trial. Can J Urol. 2020 Feb;27(1):10072-10079. 2. Bhojani, N, et al. Aquablation for Benign Prostatic Hyperplasia in Large Prostates (80-150 cc): 1-Year Results. Urology. 2019 Jul;129:1-7. 3. Data on file at PROCEPT BioRobotics.
What Is The Cost Of Aquablation Therapy?

The cost of Aquablation therapy will depend on what country you live in and what type of insurance you have.
Does My Insurance Cover Aquablation Therapy?

For patients in the United States, two of the major national private insurance companies (Anthem and Humana) have issued positive coverage policies for its patients. For all other private insurance companies, coverage can be assessed on an individual basis, and you should speak with your provider directly to determine if Aquablation therapy is available for you. For patients outside of the United States, reimbursement and coverage vary by geography. We recommend patients contact their local physician providers to determine if Aquablation therapy is available.
What Is Aquablation Therapy?

Aquablation therapy is a one-of-a-kind procedure. It is the only procedure that uses a heat-free waterjet controlled by robotic technology to remove prostate tissue and combines a camera (called a cystoscope) with ultrasound imaging, giving the surgeon the ability to see the entire prostate in real time. As a result, Aquablation therapy is precise, consistent and predictable and provides long-term relief no matter how large your prostate is, and has a very low rate of irreversible complications—incontinence, ejaculatory dysfunction, erectile dysfunction.1,2 References: 1. Gilling, P, et al. Three-Year Outcomes after Aquablation Therapy Compared to TURP: Results from a Blinded Randomized Trial. Can J Urol. 2020 Feb;27(1):10072-10079. 2. Bhojani, N, et al. Aquablation for Benign Prostatic Hyperplasia in Large Prostates (80-150 cc): 1-Year Results. Urology. 2019 Jul;129:1-7.
Who Is An Appropriate Candidate For Aquablation Therapy?

Aquablation therapy has been proven as a safe and effective treatment for patients suffering from lower urinary tract symptoms (LUTS) due to BPH. Aquablation therapy can be performed on prostates of any size.
Who Performs Aquablation Therapy Surgery?

Your urologist performs Aquablation therapy using the AquaBeam Robotic System. The procedure takes place in a hospital. When our team performs embolization prior to Aquablation therapy, the PAE will be performed by a Vascular Interventional Radiologist
How Common Is Aquablation Therapy Surgery?

Aquablation therapy is commercially available in the United States, Canada, Europe, United Kingdom, the Middle East and Asia.
Is Aquablation Therapy FDA Approved?

Yes, Aquablation therapy is performed by the AquaBeam Robotic System, which was cleared by the FDA in December 2017.
Does Aquablation Therapy Have CE Mark?

Yes. Aquablation therapy is performed by the AquaBeam Robotic System, which received CE Mark in 2014.
What Are The Risks Associated With Aquablation Therapy?

The most common side effects are mild and temporary. These may include mild pain, bleeding or strain while peeing, discomfort in the pelvis, inability to empty the bladder, a frequent and/or urgent need to urinate, and bladder or urinary tract infection. Other risks include ejaculatory dysfunction and a low risk of injury to the urethra or rectum. For more information about potential side effects and risks associated with Aquablation therapy, speak with your urologist or surgeon. With the most significant risk in clinical studies being bleeding, the team has worked to improve this outcome by performing PAE or embolization prior to Aquablation. This has been performed with clinical results showing an improvement in bleeding rate, discharge to home, and complications compared to published studies.
What Are The Clinical Results?

Aquablation therapy has been studied in seven different clinical trials. It has been shown to be a safe and effective treatment for patients suffering from lower urinary tract symptoms (LUTS) due to BPH. Aquablation therapy can be performed on prostates of any size. References: 1. NCT03191734 – French Aquablation Clinical Investigation Using Waterjet Ablation Therapy for Endoscopic Resection of Prostate Tissue 2. NCT03123250 – Waterjet Ablation Therapy for Endoscopic Resection of Prostate Tissue II (WATERII) 3. NCT02974751 – Global Post-Market Registry Using Waterjet Ablation Therapy for Endoscopic Resection of Prostate Tissue (OPEN WATER) 4. NCT02505919 -Waterjet Ablation Therapy for Endoscopic Resection of Prostate Tissue (WATER) 5. NCT03167294 – AquaBeam India Study for the Treatment of Benign Prostatic Hyperplasia (ABS) 6. NCT03125863 – Acute Hemostasis Following the Use of the AquaBeam® System for the Treatment of Benign Prostatic Hyperplasia (AHA) 7. NCT03125889 – Acute Hemostasis Following the Use of the AquaBeam® System for the Treatment of Benign Prostatic Hyperplasia II (AHA II)
What Is The AquaBeam Robotic System?

The AquaBeam Robotic System performs Aquablation therapy.
Why Is The AquaBeam Robotic Surgery Better?

Aquablation therapy is a one-of-a-kind procedure. It is the only procedure that uses a heat-free waterjet controlled by robotic technology to remove prostate tissue and combines a camera (called a cystoscope) with ultrasound imaging, giving the surgeon the ability to see the entire prostate in real time. As a result, Aquablation therapy is precise, consistent and predictable and provides long-term relief no matter how large your prostate is. It has a very low rate of irreversible complications—incontinence, ejaculatory dysfunction, erectile dysfunction.1,2 References: 1. Gilling, P, et al. Three-Year Outcomes after Aquablation Therapy Compared to TURP: Results from a Blinded Randomized Trial. Can J Urol. 2020 Feb;27(1):10072-10079. 2. Bhojani, N, et al. Aquablation for Benign Prostatic Hyperplasia in Large Prostates (80-150 cc): 1-Year Results. Urology. 2019 Jul;129:1-7.
Does The Treatment Impact Sexual Function?

Aquablation therapy has a very low rate of irreversible complications (incontinence, ejaculatory dysfunction, erectile dysfunction).1,2 References: 1. Gilling, P, et al. Three-Year Outcomes after Aquablation Therapy Compared to TURP: Results from a Blinded Randomized Trial. Can J Urol. 2020 Feb;27(1):10072-10079. 2. Bhojani, N, et al. Aquablation for Benign Prostatic Hyperplasia in Large Prostates (80-150 cc): 1-Year Results. Urology. 2019 Jul;129:1-7.
What Are The Side Effects?

Once you’re home, you may experience mild burning sensation and urgency during urination for a couple of weeks. This can be managed with mild pain medication. Patients can resume their normal activities once approved by their doctor.

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