Advanced treatment for a condition affecting millions of Americans is being performed at OSF Saint Francis Medical Center by a vascular surgeon.
Using an innovative tool called an orbital atherectomy catheter, Dr. Syed Hussain of HeartCare Midwest and OSF Saint Francis Heart Hospital can shave plaque from the arteries of patients with peripheral arterial disease, also known as peripheral vascular disease. PAD, which affects up to 20 percent of Americans over age 65, is caused by a narrowing or blocking of the blood vessels due to a build-up of plaque, a substance formed by fat and cholesterol. If untreated, this condition can lead to tissue death, heart attack, stroke, aneurysms or kidney disease.
“PAD is a very prevalent problem because of the aging population,” said Dr. Hussain. “It tends to affect people over the age of 50. That’s when we begin to see a great deal of arterial problems.”
Other risk factors for PAD include diabetes and kidney failure. “It’s extremely important for people with diabetes to get screened for vascular problems because their chance of having PAD is 10 times higher than the average person over age 50,” he said. “If they have diabetes and underlying kidney issues or if they are on dialysis, their risk of PAD is 20 times greater.”
According to Dr. Hussain, symptoms vary depending on the affected arteries. If PAD affects the lower extremities—which is the most common problem—it can be characterized by pain or numbness that is brought on by activity and relieved by rest. Ulcers on the feet or toes also can be signs of PAD.
Narrowed or blocked neck arteries, or carotid arteries, can cause stroke symptoms: sudden numbness or weakness of the face, arm or leg, especially on one side of the body; sudden confusion or trouble speaking; sudden visual changes; sudden trouble walking, dizziness or loss of balance; and sudden severe headache with no known cause. A simple carotid ultrasound in high-risk individuals can help detect the problem.
However, in the majority of cases, PAD is asymptomatic. For example, abdominal aortic aneurysms are referred to as “the silent killer” because patients are not aware of them until they rupture, at which time they are generally fatal. At high risk for aneurysms are people over age 50, men, smokers and those with a family history of aneurysms. “Because there are no symptoms 70 percent of the time, it’s important for patients to get screened early for peripheral arterial problems in the neck, abdomen and legs,” advised Dr. Hussain.
The latest tool used in the treatment of PAD is the Diamondback orbital atherectomy catheter. It has a black burr made of carbon with diamond pieces that “spins like a drill as it goes through the artery and shaves off the plaque. The plaque that gets shaved off is three times smaller than the size of a red blood cell,” explained Dr. Hussain. “Therefore, particles that go down the leg are not going to impair blood flow.”
Candidates for this procedure have heavily calcified arteries versus arteries that have soft plaque. “Not all patients are candidates for this device,” he said. “The characteristics of the plaque dictate the appropriate therapy.”
More traditional treatment methods include opening the narrowed or blocked arteries by implanting a metal stent or by expanding them with a balloon angioplasty catheter. In some cases, balloon angioplasty is used in conjunction with the atherectomy catheter. “Sometimes, depending on what the result looks like, I’ll use a small balloon to sort of iron out the irregularities in the artery wall,” noted Dr. Hussain.
Advances are being made in stents and balloons as well. Drug-coated stents and balloons are being studied in trials to minimize the chance of opened arteries becoming re-narrowed. “There’s a lot of exciting technology when it comes to PAD, and so many different ways to treat these patients,” he said. “I’ve got a lot of tools in my toolbox that I can use on different patients for different reasons.”
Individuals who are at high risk for developing PAD or who are experiencing symptoms that might be caused by PAD should ask their primary care physician for a referral to a vascular surgeon for evaluation. A vascular surgeon is a specialist in treating problems of the arteries and veins outside the heart. This specialty requires five years of surgical training and two additional years of specialty training in vascular surgery and minimally invasive techniques.
“A vascular surgeon can give you the medical, surgical and interventional options,” he explained. “We are able to offer all three modalities of treatment, and we work very closely with our internal medicine colleagues to help manage medical problems.” iBi