Bart Chess, M.D., a vascular surgeon at Alleghany Health Network in Pittsburgh, Pennsylvania, talks to us about new technology that is providing relief for patients with clogged leg arteries.
Interview conducted by Ivanhoe Broadcast News in October 2016.
We’re talking about PAD today. Can you give me a quick overview of what’s going on, what kinds of problems it’s causing?
Dr. Chess: Peripheral arterial disease is a common problem in the United States and even worldwide, it effects up to twenty million people. What the result is in reference to the lower extremities is typically pain with exercise or pain with ambulation and it’s due to the result of blockages or narrowings that build up in the artery over time. There are certain patient groups that are more prone or susceptible depending on hereditary factors and a variety of associated comorbidities. Mainly high blood pressure, smoking use, people or patients with diabetes or high cholesterol tend to be the patient populations most at risk for lower extremity peripheral arterial disease.
What’s the gold standard treatment?
Dr. Chess: It’s variable; today it’s kind of switched from the traditional standard bypass surgery which required a much longer recovery. Extensive incisions on the lower extremities and a slower return to function. The newer shift has been more endovascular with new devices and new technology that allows us to actually do things that we essentially directly puncture the artery and through that small puncture in the artery we deliver a variety of devices whether they are balloons, catheters, stents or in this case even atherectomy.
I want to talk a little bit about the new application of devices that you have at your disposal to treat this. Can you talk to me about this?
Dr. Chess: This is a brand new technology actually in the world of vascular surgery what the new device or the new technology is, is actually light at the end of a catheter. There’s a variety of different catheters that we can use. There are two broad categories, there’s a crossing catheter which is referred to as the ocelot and this is used in situations where the vessel is a hundred percent occluded for the most part. Our whole goal is to try to stay in the lumen of the vessel or the center of the vessel. Then the other aspect of this is to try to remove some of that plaque or debulk that plaque and that’s through a device called the patheris atherectomy catheter. The uniqueness about these devices are that they have a light fiber at the end of the catheter that allows us to directly visualize the inside of the vessel. Traditionally we’ve been using radiographic technique so fluoroscopy to simply mortar that location of our devices and we use contrast agents to find what areas are open or blocked. This device is revolutionary for us because it allows us to see areas that are blocked; it allows us to see areas that are open. In particular we can focus or target our treatment to the areas that are most affected.
So it’s real time?
Dr. Chess: It’s real time.
You talked about one being kind of a debulking tool?
Dr. Chess: We use them together, I mean it’s usually used in sequence. The first one is to get across the area that’s blocked or narrowed, and the second device which is designed or referred to as the atherectomy catheter is actually designed to shave out the areas that are narrow or blocked.
Could you walk me through the procedure, how it would work, you go in through an artery?
Dr. Chess: This is an arterial problem, peripheral artery disease in for the most part affects the lower extremity arteries. It doesn’t affect the veins. What we’re doing is we actually start by puncturing the artery and then inserting a wire or a sheath; this is essentially a straw that allows us to take pictures. The way we image the vessel is to put contrast in the vessel and use x-ray to identify the areas that are open or blocked. That then allows us to proceed by trying to pass a wire through the areas that are blocked or narrowed. That’s where this new technology comes in to direct play because the one catheter allows us cross areas that are a hundred percent blocked and in addition we’re also trying to stay within the confines of the vessel not into the layers of the vessel. The vessels are very much like an onion skin there’s multiple layers to them. Our goal is to try and stay in the center of the blood vessel if we can do so and then after we cross it we use the atherectomy catheter more or less to debulk or clean out the areas that are blocked.
Why is It important to stay towards the center, what are you trying to avoid?
Dr. Chess: Well the novel thing about this technology is it affords us the opportunity to stay in the center of the vessel. The advantage we think at this point is early evidence suggests that there’s a patency advantage or the chance that the vessel stays open after we treat it. We in effect have been able to or at least the early preliminary data has suggested that we’re able to do it with less stents. We leave less material behind which reduces cost to the patient or to the healthcare system. We also are able to hopefully really at the end of this reduce injury to good parts of the vessel by traumatizing it with our devices. In doing so we in effect may be able to increase or maintain long term patency.
You’re talking about debulking, can you explain that?
Dr. Chess: Debulking is it simply means taking out or removing areas of narrowing within the lumen of the vessel, or the lining of the vessel to open it up and make it wider.
Who are the best candidates for this procedure.
Dr. Chess: That’s an ever changing question. At this point right now where we’re studying this or where it’s designed its utility is in the lower extremities and particularly in what we call the femoral popliteal segment. We’re also extrapolating that with new devices and new designs that actually start working even into the smaller blood vessels in the calf. For the most part it’s designed from anywhere in the upper thigh region or the groin region all the way down through the knee and again into some of the smaller blood vessels in the calf.
How effective has it been for the patients?
Dr. Chess: Very effective. We’ve seen very good results, we’ve seen patients basically come in, have their procedure, have the atherectomy where we’ve removed the plaque and they’re basically up and leave the hospital the same day and are walking and have done quite well.
END OF INTERVIEW
This information is intended for additional research purposes only. It is not to be used as a prescription or advice from Ivanhoe Broadcast News, Inc. or any medical professional interviewed. Ivanhoe Broadcast News, Inc. assumes no responsibility for the depth or accuracy of physician statements. Procedures or medicines apply to different people and medical factors; always consult your physician on medical matters.
If you would like more information, please contact:
Douglas Braunsdorf
412-330-4456
Douglas.braunsdorf@highmarkhealth.org
Sign up for a free weekly e-mail on Medical Breakthroughs called
First to Know by clicking here.
