Peripheral and Endovascular

Peripheral arterial disease (PAD) is the narrowing of any of the arteries to the legs, kidneys, stomach, arms, brain, and other organs. This condition increases the likelihood of a heart attack or stroke. 

The most common symptoms of PAD include leg or arm discomfort while exercising, leg ulcers, and other serious complications, such as gangrene. 

PAD affects almost 10 million patients, yet it remains one of the most underdiagnosed and undertreated conditions. 

PAD Expertise at Weill Cornell Medicine 

Our team of vascular specialists includes experts in diagnosing and treating abnormalities of the vascular/circulation system, including PAD. 

At the Maurice R. and Corinne P. Greenberg Division of Cardiology, our vascular specialists are board certified in vascular or endovascular medicine, cardiovascular disease, and interventional cardiology. They have received extensive training, including a fellowship and additional specialization in vascular procedures.

Noninvasive Vascular Imaging 

To accurately diagnose abnormalities in the vascular system, our specialists use the most advanced, contemporary noninvasive tests available. These tests use cuffs—similar to those used to measure arm blood pressure and ultrasound technology—and can be conveniently performed during a regular office visit. 

At Weill Cornell Medicine, our Peripheral and Endovascular Service offers: 

• Ankle-brachial index (ABI) test 
• Treadmill exercise test
• Pulse volume recording (PVR) test 
• Arterial and venous (Doppler) ultrasound

We also provide CT angiography (CTA) and magnetic resonance angiography (MRA) to ensure the most accurate diagnosis possible. 

Personalized Approach to PAD Treatment

Our team of vascular specialists offers a comprehensive, multispecialty, cutting-edge approach to the evaluation and care of patients with PAD. We offer the most advanced minimally invasive treatment options. 

We will work closely with our patients and referring physicians to coordinate a personalized treatment plan for every patient. Our goal is to understand our patient’s condition and then treat it in a way that improves his or her lifestyle and prevent future vascular problems. 

Treatment Options

Each patient receives a unique treatment plan tailored to his or her specific condition and lifestyle goals. Treatment options may include: 

Medical therapy: Medical therapy is an integral part of treatment for all patients with peripheral arterial disease. Drug therapy is used to target leg or arm discomfort that occurs with exertion and as a result of clogged arteries. Medications are also used to treat underlying conditions such as diabetes, hypertension, and high cholesterol.

Lifestyle changes: Improvements in lifestyle are crucial for preventing future vascular complications. We help patients: 

• Develop an exercise plan to help walk longer and faster without pain
• Quit smoking with our guidance and education 
• Make additional lifestyle changes—including diet—as needed 

Minimally invasive endovascular treatments: Our experienced interventional cardiologists specialize in performing minimally invasive procedures. These are performed through a small opening in the groin or arm (not open-heart surgery), resulting in a shorter recovery period and fewer complications. Clogged arteries can be treated with balloon angioplasty, placement of stents, or atherectomy (plaque excision from the artery).

Areas of Expertise

• Angioplasty, drug-coated angioplasty and stenting for peripheral arterial disease: Our physicians use a small balloon-tipped catheter that is threaded through the clogged artery to expand it. A stent may be inserted to relieve the blockage and to keep the artery open. Bare metal stents or drug-eluting stents are commonly used to treat clogged arteries.
• Chronic total occlusions: Our experienced physicians can relieve blockages in the arteries that are entirely blocked, particularly blockages that have been present for months and sometimes for years.
• Limb ischemia: Treatment of patients with leg or arm discomfort at rest, the presence of ulcers or gangrenes.
• Endovascular repair of abdominal aortic aneurysms (AAA): Minimally invasive treatment for many people with an abdominal aortic aneurysm, and an alternative for some who do not qualify for open surgery.
• Atherectomy (plaque excision): A catheter is used to remove the plaque from the artery. Our specialists use cutting-edge technology, including rotational, excisional, orbital, and laser atherectomy.
• Renovascular disease: Clogged renal arteries can lead to hypertension, which is difficult to treat with medications, kidney failure or heart failure. These clogged kidney arteries can be treated with angioplasty and stenting.
• Intravascular ultrasound and fractional flow reserve (FFR): An ultrasound catheter can be threaded through the clogged artery to determine the severity and location of a given blockage. A Fractional Flow Reserve wire is threaded through a blockage and used to measure whether the blockage is detrimental and needs further treatment.
• Inferior vena cava filter placement and retrieval: Small filter devices are placed in a large vein (vena cava) to prevent clots from traveling to the lungs. These methods can be used for both prevention and treatment of patients with clots formed in deep veins.
• Carotid disease and carotid stenting: Carotid artery angiography and stenting (with filter devices in the arteries of the neck that catch plaque particles) can be performed for patients with severe blockages of carotid arteries, particularly in those experiencing strokes or mini strokes.
• Chronic venous insufficiency (CVI): The latest minimally invasive approaches for treatment of venous disease including vein radiofrequency ablation (RFA), a technique in which a catheter delivers microwave radiation to seal veins that have “reflux.” Chronic venous insufficiency describes a condition affecting the veins in the legs with venous hypertension. This can lead to a pain, swelling, edema, skin changes, and ulcerations in the legs.