Peripheral Vascular Intervention

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	SUNY Downstate Medical Center 450 Clarkson Avenue Room A2-523 (cardiac cath lab) Brooklyn, NY 11203-2098 Cell: 917-885-8854 more contact information

Dr. Jonathan Marmur directs the SUNY Downstate Vascular Medicine Clinic in order to evaluate patients who may be candidates for endovascular intervention.

Carotid Artery Stenting has emerged as an endovascular treatment alternative to carotid endarterectomy for the management of atherosclerotic obstructive extracranial carotid artery disease. Evidence is accumulating in support of its efficacy in preventing stroke. Dr. Marmur has achieved a high level of proficiency in catheter-based intervention, has completed dedicated training in carotid artery stenting, and is the exclusive cardiologist credentialed at SUNY Downstate Medical to perform this procedure.

Peripheral vascular disease of the lower extremities is an important cause of morbidity that affects up to 10 million people in the US. More than 70 percent of patients remain stable or improve with conservative management. Those who do not may undergo contrast, CT, or MR angiography, which may be used in planning for surgery or percutaneous intervention (angioplasty).

Intermittent Claudication
Intermittent claudication (leg pain or discomfort while walking that abates during rest) is the most common symptom. Other symptoms include numbness or weakness in the legs, aching pain in the feet or toes while at rest, nonhealing ulcers on the leg or foot, cold legs or feet, and skin color changes.

The iliac arteries are technically among the easiest vessels to approach percutaneously. The technical success of stent placement in aortoiliac occlusive disease is 96 percent with five-year patency rates of 86 percent approaching that of surgical bypass.

Superficial femoral artery stenosis or occlusion is the most common lesion associated with claudication. Surgery or percutaneous angioplasty (usually followed by stenting) is indicated for relief in patients with claudication that limits their lifestyle or ability to perform their job and that has proved to be unresponsive to exercise and pharmacologic therapy. Data from two randomized trials indicate that surgery and angioplasty result in similar mortality and amputation rates and in similar patency rates at 4 years among patients with ischemia of the legs or feet. However, because angioplasty is associated with lower estimated rates of both short-term mortality and major complications, angioplasty is preferred for lesions with favorable anatomical features, such as discrete stenoses or occlusions (those less than 15 cm long)

Infrapopliteal angioplasty is generally reserved for use in patients with limb-threatening ischemia. Limb salvage rates have been reported up to 72 percent.

Renal artery stenosis may cause hypertension and renal insufficiency. Technical improvements in endovascular tools have lead to a more widespread use of percutaneous renal artery revascularization. Numerous single-center studies have reported the beneficial effects of angioplasty or stenting of renal artery stenosis caused by fibromuscular dysplasia or atherosclerosis, respectively. Despite the absence of sufficient randomized studies, there is nonetheless evidence that stenting of hemodynamically significant atherosclerotic renal artery stenosis has an impact on blood pressure control, renal function, and left ventricular hypertrophy.