Date: 3/20/2006

Community hospital first to use ’cool’ new tool

MUNSTER—Physicians at Community Hospital are offering new hope to patients suffering from Critical Limb Ischemia (CLI), the most severe form of peripheral arterial disease common in people with diabetes.

CliRpath® (Cool Laser Revascularization for Peripheral Artery Therapy) is a cool laser treatment that vaporizes all types of blockages — especially below the knee where the arteries are small and narrow. The cool laser catheter delivers rapid and continuous bursts of ultraviolet energy to the target site eliminating the obstruction without damage to the surrounding artery. Unlike other lasers, this “cool” laser does not burn.

Cardiologists Arvind Gandhi, M.D. and Prakash Makam, M.D. have performed the procedure at Community Hospital in Munster, Ind., the only hospital in Northwest Indiana to offer this laser treatment. The cool laser is the newest technology available to clear blockages in the leg, giving physicians at Community Hospital added options to help patients avoid amputations.

According to the American Diabetes Association, nearly 100,000 people lose a foot or leg to diabetes annually. Diabetic patients often develop vascular disease in their legs that limits blood flow and can lead to chronic, non-healing wounds, and eventually amputation.

In addition to treating peripheral arterial disease, CliRpath® is being used to extract deep muscle electronic leads that had been part of implanted defibrillators or pacemakers. The cool laser treatment can be used to vaporize leads during the extraction procedure.

“When a lead is placed into the heart, scar tissue forms in two spots — in the heart chamber itself and at the site of the lead tip within the vein,” said Gandhi, chairman of Cardiovascular Services and Cardiac Catheterization Labs for Community Hospital. “Usually, one of two situations happens. Either the lead is infected and we have to take it out or there are too many leads in the chest because the patient has had their pacemaker for many, many years. In the past, the preferred course of treatment was to leave (the lead) alone. However, with CLiRpath laser treatment, I see the frequency of lead removal increasing because it only removes the obstruction — blood clots and cholesterol plaque — without leaving debris. It is much safer for the patient.”

Both physicians agree that CLiRpath® cool laser is a good supplemental treatment to balloon angioplasty and stenting. Another new catheter device, called SilverHawk plaque excision system, has also been used to remove plaque from blocked arteries in the leg.

“Our goal is to dramatically reduce the number of amputations per year,” Makam said, “CLiRpath® is a useful tool in treating peripheral vascular disease and CLI. Once we’ve established straightline flow to the foot, circulation improves and healing begins in the ulcers, wounds or gangrene. The results are immediate and can be seen on the angiogram. The patient continues to benefit in the subsequent days, weeks, and months ahead.”

During balloon angioplasty and stenting, a tiny incision is made in the upper thigh, and a catheter is inserted into the femoral artery and guided to the heart. Then, a balloon at the catheter tip is inflated inside the vein to block blood flow while a stent — a small wire mesh tube — is expanded inside the vessel to keep the walls open. The stent remains behind as a support brace.

Results from balloon angioplasty and stenting alone in patients with CLI, tend to be inferior because deposit material — blood clots, plaque, calcium build up — can leave behind debris that can rebuild or compress and break up and travel through the bloodstream, lodging in the body and causing other complications.

CLiRpath® cool laser vaporization and Silver Hawk’s rotating blade first eliminate blockages in the vein, removing the material completely from the body. These nonsurgical options for restoring blood flow to lower limbs are increasingly being used in patients with CLI who are at high risk for amputation.

Patients, once faced with the possibility of losing a limb, can now look to the physicians at Community Hospital and the FDA approved CLiRpath® procedure to regain blood flow in their lower extremities, increase their chance of healing, and ultimately improve their own physical and psychological well-being.