Peripheral Artery Disease Center

Overview: A Multidisciplinary Approach to Vascular Care

Clinicians at the Massachusetts General Hospital Fireman Vascular Center are leaders in the development and use of medical, endovascular and surgical interventions to diagnose, treat and prevent complications of peripheral artery disease (PAD), a circulatory condition in which arteries narrowed by atherosclerosis (buildup of plaque within the arteries) reduce blood flow to the limbs, particularly to the legs and arms.

The Mass General Fireman Vascular Center is one of the only vascular centers in the country with specialists in every area of vascular disease. Our Peripheral Artery Disease Center brings together a team of clinicians from multiple disciplines to provide care from many perspectives, including:

• Endocrinology
• Foot and ankle orthopedics 
• Nutrition
• Physical therapy
• Podiatric medicine
• Vascular and endovascular surgery
• Vascular imaging and intervention
• Vascular medicine and cardiology
• Vascular and cardiovascular nursing services
• Wound care

We work together with each patient and their referring physician to coordinate a personalized treatment plan.

Diagnosis

Our team includes experts in diagnostic imaging who are specially trained to detect abnormalities in the vascular system and whose practice focuses specifically on vascular disease. These vascular imaging specialists are board certified in vascular medicine, vascular surgery, vascular radiology and imaging, and are fellowship-trained with additional specialization in vascular procedures.

To diagnose PAD accurately, our specialists rely on noninvasive tests that use inflatable cuffs similar to those used to measure blood pressure. These tests can be performed during a regular office visit and 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 Mass General to measure the blood flow in the upper and lower extremities

Other diagnostic techniques include:

• Duplex ultrasound, which uses sound waves to evaluate blood flow
• Computed tomography angiography (CTA), where dye is injected into the vein to get detailed images of blood vessels and tissue
• Magnetic resonance angiography (MRA), a type of MRI that provides images of blood vessels

All of our diagnostic tests may also be performed at our convenient Waltham location.

Treatment Plans

Depending on the disease severity, PAD symptoms may range from leg discomfort while walking to severe pain at rest or skin breakdown with ulceration. Our goal is to design individualized treatment plans that enable patients to lead active lifestyles and minimize the risk of cardiovascular complications. To treat PAD, our clinicians consider several therapeutic options, including:

• Medical therapy: Medications are used to 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: Preventive care is central to the treatment process. Our vascular specialists guide patients through smoking cessation and other lifestyle changes to treat associated conditions

• Exercise therapy: This approach helps patients walk further 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 are able to 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 and is expanded permanently into the vessel wall, propping open the blockage

• Atherectomy: A specialized catheter with directable cutting blades, laser tip or polishing drill is advanced through the cholesterol plaque repeatedly, removing plaque debris from the vessel wall to restore flow in the channel

Surgical techniques, such as:

• Endarterectomy: Through a surgical incision, the blocked artery is exposed and opened. The plaque is then removed, resulting in a widening of 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. 

Additionally, we work in close collaboration with cardiologists at the Mass General Corrigan Minehan Heart Center to treat associated cardiac conditions. Our clinicians follow patients long-term to ensure ongoing, personalized care over a lifetime.

Limb Evaluation and Preservation Program (LEAPP)

Through the PAD Center, the Mass General Limb Evaluation and Preservation Program (LEAPP) specializes in the multidisciplinary care of patients with PAD. LEAPP is committed to reducing amputation rates and providing world-class, evidence based, comprehensive care for our patients.

Committed to Increasing Awareness of PAD

The Fireman Vascular Center has a long tradition of excellence in clinical care, with clinicians who are considered national leaders in the diagnosis and treatment of PAD. Our physicians are dedicated to pioneering research and serve on many national and international professional boards and societies, including the:

• Society for Vascular Surgery
• Society of Interventional Radiology
• American College of Cardiology
• American Heart Association
• Society for Vascular Medicine
• Society for Cardiovascular Angiography and Interventions
• American Board of Vascular Medicine
• Intersocietal Commission for the Accreditation of Vascular Laboratories

Our clinicians also are committed to educating patients regarding PAD and its risks. Mass General was the first hospital in the United States to partner with the Peripheral Arterial Disease Coalition, a national campaign funded by the National Heart, Lung and Blood Institute and designed to increase public awareness of PAD.

Evaluating New Technologies Through Research and Clinical Trials

The Fireman Vascular Center participates in major clinical studies that evaluate new technologies and devices to treat PAD. This allows us to bring our patients promising new treatments as quickly as possible. This innovative work is focused on:

• New devices: Since 1997, the Fireman Vascular Center’s vascular ultrasound core laboratory (VasCore) has been a leader in the design, development and implementation of clinical trials on new endovascular devices
• Drug-eluting stents and drug-coated balloons: Our clinicians are national leaders and pioneers in investigations to determine if the use of drug-eluting stents (stents that slowly release medication to prevent a recurring blockage) and drug-coated balloons can keep arteries open longer after minimally invasive PAD treatments.
• Surgical and endovascular treatment options: Our physicians focus on team-based care and are leading major national investigative efforts to determine the roles of surgery and endovascular treatment in patients with the most advanced forms of PAD
• Patients interested in participating in clinical trials can browse online for open trials

Tracking Outcomes to Improve Care

The Fireman Vascular Center has taken the unprecedented step of independently following the outcomes of patients who are evaluated for PAD. While treating patients, we carefully document how they respond. These tracking systems ensure that we deliver quality care during a procedure and throughout a patient’s recovery.

Patients and family members can feel confident that our team is always striving to provide the best possible outcome.

One Call Coordinates Care

Our access specialist is available Monday through Friday from 8:30 am to 5:00 pm to take relevant information about your condition and symptoms, and to make a timely appointment with the most appropriate specialist. Call 877-644-8346 to reach our nurse coordinator or request an appointment online

We strive to see patients as soon as possible and assign every patient one clinician to organize care between members of our multidisciplinary team. From diagnosis to treatment and follow-up, this physician guides patients through the care system and treatment process.

Why Mass General?

Mass General is consistently recognized as a top hospital in the nation by U.S. News & World Report. Our recognition is based on our quality of care, patient safety and reputation in different specialties. Our commitment to excellence means that we work to ensure that you receive the best care.

Rona Cavallaro, NP
Lead Administrator and Coordinator, Mass General PAD Center

Lindsey Ferraro, RVT
Lead Vascular Lab Technologist

Maureen McCarthy, NP
Lead Wound Care Specialist

Edgar Rodriguez, MSPO, CPO
Hanger Prosthetics Clinic (Mass General)

Kathleen Traynor, RN
Supervised Exercise Therapy (SET)