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News

New procedure shaves away plaque in patients with poor leg circulation

Emory University : 12 February, 2007  (Technical Article)
Tired, aching legs, cold feet and wounds or blisters on the feet that won't heal, these are all symptoms of a condition called peripheral vascular disease or PVD. The disease, similar to coronary artery disease, causes a build-up of plaque most commonly in the legs and feet, which leads to poor circulation in the lower extremities.
In severe cases, patients can even lose a limb because of lack of circulation. Now a new, minimally invasive procedure is helping patients to get back on their feet again by simply shaving away the plaque build-up in the legs. The new procedure means no major surgery and a shortened stay or even no hospital stay for these patients.

'Peripheral vascular disease is very prevalent in the older population,' says Khusrow Niazi, MD, FACC, assistant professor of medicine (cardiovascular diseases) at Emory University School of Medicine and cardiologist at the Carlyle Fraser Heart Center at Emory Crawford Long Hospital. 'The highest-risk patients are people above the age of 50 who are smokers, people above the age of 50 who have diabetes, or people above the age of 70. So it's a disease of aging. We also see PVD in patients with high cholesterol and hypertension. The older the people get in our population, the more we are going to see this problem.'

If left untreated, PVD increases the risk of heart attack, stroke, amputation and even death. The most common forms of treatment for PVD have been surgery to bypass the blocked artery in the leg, or placing a permanent stent in the artery. But now, a new treatment option offers a lower risk for these older patients.

During the procedure, the shaving device is inserted into the groin of the patient through a catheter and is tunneled down to the blocked artery. A tiny rotating blade in the device shaves away the plaque inside the artery, which is called plaque excision. The plaque is collected in the tip of the device and then is removed from the patient. Blood should once again flow through the artery normally. Before and after the procedure, contrast dye is injected into the artery to closely examine the blockage and the results under live X-ray. The patient is awake during the procedure.

The device, called the SilverHawk Plaque Excision System made by FoxHollow Technologies, is FDA-approved. Most insurance companies cover this plaque excision procedure.

'This new procedure is really giving hope to patients who have severe cases of PVD,' says Dr. Niazi. 'In some of these patients, foot and leg wounds that do not heal often lead to gangrene and amputation. While amputation is still being used as a treatment for severe cases, we are trying to change that and make this procedure more widely known. If we can see patients early on, when they start developing discomfort in their legs and feet, then we can stop this disease in its tracks. Our goal is to keep both feet on the patient so they can continue to get around on their own.'

Following the procedure, patients either go home the same day or spend one night in the hospital. The next day, they are encouraged to walk, which is the best exercise for their legs.

While doctors say the procedure is successful 98 percent of the time, complications can sometimes occur. They include a reaction to the contrast dye or the possibility of a tear in the artery wall, which could mean surgery to repair the tear. But doctors say the complications are rare and the risks are minimal.

Dr. Niazi has done more than 200 of these procedures at Emory Crawford Long Hospital.

'When you help a patient heal their wound and prevent an amputation, that is an ecstatic feeling,' Dr. Niazi explains. 'And that is priceless for us as physicians when we see the happiness and joy in our patients.'
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