Date: 11/10/2009

New advancements in the treatment of PAD at Community Hospital

Thanks to a new device called Diamondback 360 Orbital Atherectomy System for the treatment of PAD and the help of Dr. Prakash Makam, Merrillville resident Joe Modic is now able to walk without pain.

At 66 years of age, Merrillville resident Joe Modic insists he isn’t ready to slow down, but six months ago, getting around seemed to be next to impossible. He has a long commute downtown to the Civic Opera House on Wacker Drive with an equally long walk from the lot where he parks to the building. Back home, he likes to take his two dogs — Scruffy and Muffin - for a walk and give them as much exercise as possible.

“I couldn’t get from the car to work and I couldn’t walk the dogs,” Modic explained. “I didn’t realize it at the time, but blockages in my lower legs were zapping my energy and causing incredible pain.”

During his appointment with family physician William Forgey, M.D. last June, 2009, Modic underwent a Doppler test or ankle-brachial index (ABI) screening. An ABI is a simple and reliable means for diagnosing peripheral arterial disease or PAD in the legs.

Peripheral Arterial Disease or “PAD” is sometimes also known as peripheral vascular disease or “PVD”. Arteries can slowly become narrowed or blocked as a result of aging, smoking, high blood cholesterol or diabetes. Lack of blood flow to the legs can make them hurt. PAD can usually be effectively treated by a healthier lifestyle, daily exercise and medications to decrease leg pains and improve one’s chance of avoiding a heart attack or stroke. For individuals with the most severe blockages, skin ulcers, non-healing wounds or even gangrene can occur. With prompt treatment, pain can be lessened and amputation may be avoided.

During the 15-minute screening procedure, blood pressure measurements are taken at the arms and ankles using a pencil shaped ultrasound device called a Doppler (an instrument that produces sound waves). These are considered noninvasive because they do not require the use of needles or catheters. The ABI test is simple enough to be performed in a doctor’s office or vascular laboratory. Not only is the ABI one of the most reliable tests for PAD, it is also the least expensive. It can assess the severity of an individual’s atherosclerosis (build up of plaque) as well as the risk of developing life-threatening conditions such as heart attack and stroke.

After Dr. Forgey saw the results of Modic’s screening, he immediately made an appointment for him to see Prakash Makam, M.D., interventional cardiologist and medical director of cardiovascular research at Community Healthcare System.

“When I first met Joe, like many diabetics, he had PAD in both legs,” says Makam. “However, his left leg had such extremely heavy calcified plaque that it was causing a 99 percent blockage, which needed immediate attention. I was confident we could help.”

First in the Chicago area to utilize a device known as the Diamondback 360°™ Orbital Atherectomy System, Makam was able to “sand away” hardened plaque - a calcified material that builds up on the inside walls of blood vessels - in a minimally-invasive procedure and offer Modic new hope of walking without pain.

“I’ve found that the Diamondback system is an effective option in removing some of the hardest, most difficult, heavily calcified plaque that had deposited in the lower extremity arteries as often seen in diabetics,” says Makam.

Orbital atherectomy is the latest technological advancement in the treatment of PAD. The procedure uses a small, diamond-coated crown designed to remove even the toughest kind of plaque without damaging the arteries. This offers new hope to patients with disease in small arteries, or those with plaque that has become hardened, calcified.

The treatment is a minimally invasive procedure; some patients are able to go home the same day while others stay overnight for observation. The device is inserted into the patient’s leg artery through a tiny puncture made in the groin. A small catheter and guide wire are used to direct the device to the location of the plaque in the artery.

Over the past two years, there have been new treatment options for PAD, and physicians on staff at the hospitals of Community Healthcare System have been among the first to introduce many of them.

We are making real advances in the treatment of PAD that will lead to fewer amputations and a better quality of life for so many people, says Makam.

“Now I have more energy and no pain,” says Modic. “I’m walking again, but I’m walking differently — at a clip. I walked my dogs twice today and I’m still rarin’ to go!”

For more information on PAD and cardiovascular research offered through the hospitals of Community Healthcare System, visit