Deaconess Medical Center plans this month to begin using a relatively new procedure to treat peripheral vascular disease.
The condition, also known as peripheral arterial disease, occurs when plaque builds up and narrows arteries in a patients arms and legs, causing pain and numbness and potentially leading to amputation of part of a limb due to lack of circulation, says Jan Schmidlkofer, a cardiovascular technologist and manager of the Spokane hospitals cardiac-catheterization laboratory.
The new procedure, called atherectomy, involves cutting and removing plaque from the artery walls using a special device attached to a catheter. Made by Redwood City, Calif.-based FoxHollow Technologies, the devices brand name is the Silverhawk Plaque Excision System.
The plaque-removal device includes a rotating cutting blade that shaves plaque from the artery wall, then pushes the shavings into a cone-shaped storage compartment in the catheters tip. This keeps chunks of plaque from moving through the bloodstream and potentially blocking a narrow passage elsewhere, Schmidlkofer says.
The device most frequently is used on arteries in a legtypically the femoral artery or the superficial femoral artery, which run parallel to one another down the length of the leg, she says.
A physician performing an atherectomy typically will insert the catheter in a patients femoral artery near the top of the leg and guide the device to the narrowed portion of the artery, viewing the catheters progress via X-ray fluoroscopy and guiding the excision device with a small handheld instrument attached to the catheter on the outside of the patients body.
If the device is used on the subclavian artery in a persons arm, a physician typically will insert a catheter into that artery near a patients shoulder.
At Deaconess, physicians from Spokane Cardiology PS, of Spokane, will be performing the new procedure.
Craig Britten, a Sammamish, Wash.-based district sales manager for FoxHollow, says the device received U.S. Food and Drug Administration approval in June 2003, and the technology currently is being used at more than 500 sites throughout the U.S.
Deaconess will be the sixth hospital in Washington state to begin using the device, and the first in the Spokane market, Britten says. He says, though, that the company currently is talking with Sacred Heart Medical Center here about the technology.
Schmidlkofer says stenting procedures and balloon angioplasty conventionally have been used to treat peripheral vascular disease, just as they are standard treatments for coronary artery disease.
An earlier generation of the Silverhawk system that included a balloon had been used in coronary arteries, but isnt as popular as angioplasty and stenting, Britten says. FoxHollow plans to start a clinical trial next spring that will test the effectiveness of the current Silverhawk systems ability to remove plaque in coronary arteries.
Using an excision device similar to the Silverhawk system, atherectomy also has been used to treat coronary-artery disease here, but isnt used nearly as often as angioplasty and stenting procedures, Schmidlkofer says.
Atherectomy might be used more frequently to treat narrowing leg arteries in hopes of curbing the recurrence of plaque buildup there, Schmidlkofer says. Studies have shown that plaque builds up again 20 percent to 30 percent more frequently in leg arteries than it does in coronary arteries, she says.
If this becomes the modality of choice, wed be using it 10 to 15 times a month, Schmidlkofer says.
Whether that occurs depends on if physicians embrace the new technology or stick with stenting and balloons, she says.
The disadvantage of the excision system is that it might not be able to penetrate plaque in places where an artery is closed. Also, as with stenting and angioplasty, the danger exists that an artery might be perforated during the procedure.
The Silverhawk catheters are one-time use devices and cost $2,600 each, Schmidlkofer says. Stenting is comparable in price, she says. Balloon angioplasty is less expensive, but a higher recurrence of plaque buildup occurs with that procedure.
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