inimally Invasive Catheter-Based Interventions Are Increasingly Used To Treat The Estimated Eight Million Americans With Severe Blood-Vessel Blockages In Their Legs, A Painful Condition Known As Lower Extremity Arterial Vascular Disease
Columbia University Medical Center, Weill Cornell Medical College Researchers Lead Study at NewYork-Presbyterian Hospital
NEW YORK – (Monday, Oct. 22, 2007) - Minimally invasive catheter-based interventions are increasingly used to treat the estimated eight million Americans with severe blood-vessel blockages in their legs, a painful condition known as lower extremity arterial vascular disease. A new study shows the approach is safe and effective and may now be considered a first-line intervention for all patients—even those with the severe form of the disease associated with risk for amputation.
Published in the September Annals of Surgery, the study was led by a vascular surgery team from the Columbia University Medical Center and Weill Cornell Medical Center campuses of NewYork-Presbyterian Hospital.
Researchers looked at a series of 1,000 catheter-based, or intravascular, interventions—including balloon angioplasty, stenting and atherectomy (a.k.a. rotorooter). They found that the treatment was still effective in nearly 80 percent of patients with claudication—a moderate form of the disease presenting as pain or fatigue with walking—at three years. Among patients with the severe limb-threatening form of the disease with risk of amputation, there was salvage of the limb in 80 percent of patients. Intravascular interventions also had a much reduced risk of complication or death, compared to traditional open surgical bypass.
“Our study presents evidence that intravascular interventions may be considered the first choice for patients with lower extremity vascular disease that does not respond to medication or lifestyle modification,” says senior author Dr. K. Craig Kent, chief of vascular surgery at NewYork-Presbyterian Hospital and the Greenberg-Starr Professor of Surgery at Weill Cornell Medical College and professor of surgery at Columbia University College of Physicians and Surgeons.
“We found that the intravascular interventions also had very good durability—close to that of open surgery. For traditional bypass, the most widely cited rate of patency, or lack of blockage, is 80 percent after five years,” continues Dr. Kent. “And, for those who need it, re-intervention is an option—something that isn’t with a failed bypass. Catheter-based re-interventions are also highly successful, with as many as 70 percent of blockages remaining open after two years.”
According to Dr. Kent, future studies will look at the effectiveness of intravascular interventions beyond three years.
The first catheter-based intervention, the balloon angioplasty, was introduced in 1974. The first coronary angioplasty was performed in 1977. Since that time, several other intravascular techniques have been developed, including atherectomy, stents and laser treatment. “Among all the other reasons, patients also prefer catheter-based surgeries because of their greatly reduced discomfort and quicker recovery compared to open bypass,” says Dr. Kent.
The study’s principal investigator was Dr. Brian G. De Rubertis, a vascular surgery fellow at NewYork-Presbyterian Hospital. Additional co-authors from Weill Cornell Medical College and Columbia University College of Physicians and Surgeons—affiliates of NewYork-Presbyterian Hospital—include Dr. James F. McKinsey, Dr. Roman Nowygrod, Dr. Nicholas J. Morrissey, Dr. Alan Weinberg, Dr. Rabih A. Chaer, Dr. John Karwowski, Dr. Harry L. Bush and Matthew Pierce.
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