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Articles / 2008

Peripheral artery disease treated
A minimally invasive way to get the plaque out

By Michelle L. Klampe
Ventura County Star
Friday, March 7, 2008

Jim Wingate did something a month ago that a few years ago seemed impossible. He packed up and moved from Ventura to Eureka so he and his wife could enjoy the hiking and other outdoor activities of the northern coastal hamlet.

Wingate, 64, credits the move to Ventura vascular surgeon Dr. Shawn Skillern, who used a minimally invasive procedure to treat Wingate's peripheral arterial disease by removing plaque from his arteries and restoring blood flow to his legs and feet.

"Now I can walk a couple of miles without pain," Wingate said.

Peripheral arterial disease occurs when plaque builds up in the arteries of the legs, impeding circulation and causing pain in the hips, thighs, knees, shins or feet. The disease affects about 8 million Americans. Risk factors include age, smoking, diabetes and high cholesterol, according to the American Heart Association. Heredity can also be a factor.

Although the disease is often misdiagnosed, catching and treating it is critical, because sufferers face a four to five times greater risk of heart attack or stroke. The disease can be treated with lifestyle changes and medication, or with minimally invasive procedures such as angioplasty, or atherectomy using the SilverHawk catheter, where the plaque is removed. Severe blockages may require surgery or even amputation, especially if gangrene develops.

Wingate was diagnosed with the disease 10 years ago and told he'd be looking at amputation within three years because of the severity. An avid hiker, he dismissed the prognosis, deciding he would try to beat the odds by staying active and healthy.

When he finally went to see Skillern on the advice of his primary-care doctor, Wingate was experiencing leg pain when he walked more than 100 yards and required frequent rest breaks during his favorite 7- or 8-mile hikes through Matilija Canyon.

"Your feet turn white, then kind of blue," he said. Wingate had a 100 percent blockage in one leg and a 70 percent blockage in the other, both behind his kneecaps.

In four procedures over a span of several months, Skillern threaded the special catheter through Wingate's groin and into the affected arteries to cut out and remove the plaque blocking the blood flow.

"It essentially made him a new man, with no limitations," Skillern said

Skillern said one advantage of the SilverHawk procedure is that it affects the body less than angioplasty and can reach areas, such as the back of the knee, that are sometimes difficult to treat.

The procedure also can be repeated if the plaque builds up again.

Because it does not require a major incision or general anesthesia, the procedure can be performed on people who aren't good candidates for surgery.

"Some of these people are so sick that traditional methods of getting blood flow restored aren't available," Skillern said.

Skillern has used the device in about 100 procedures at Community Memorial Hospital in Ventura over the past two years. He often doesn't know until he has a patient in the catheterization lab and has seen pictures of the arteries whether it will be the right tool to address their blockage.

In one recent case, he injected dye into an elderly Santa Barbara man's arteries, watched it flow through the veins in the man's lower extremities, and pondered his options. The man had already had a bypass on his right leg. Skillern found that a blockage in the upper left thigh was a good candidate for plaque removal using the SilverHawk.

In minutes, he threaded the catheter through the man's groin and positioned the SilverHawk so the tiny rotating blade could chisel out the stringy white plaque, an amount about the size of a grain of rice.

The plaque is captured in a receptacle in the catheter and removed from the body with the device. Removing just a little bit can promote better blood flow and improve the patient's quality of life, Skillern said.

"The goal is to significantly improve the blood flow getting to the extremity," he said. "You can see it on the monitors as you literally remove the plaque and open up the artery."

Patients are up and walking hours after the procedure, and because it's minimally invasive, they can return to normal activities quickly.

"I noticed an improvement immediately" after the first procedure, said Wingate, now retired from the Ventura County Medical Examiner-Coroner's Office. His last procedure was about four months ago, and a month ago, he moved up north to take advantage of his newly pain-free legs.

"Now I go down to the marsh every day and walk," he said.

The SilverHawk isn't for every doctor. Some prefer angioplasty.

"Some doctors get really excited about it," said Dr. Charles Hennemeyer, an interventional radiologist with Los Robles Radiology Associates who works at Los Robles Hospital and Medical Center in Thousand Oaks. "It's not the greatest device ever. I don't reach for it a lot."

"The SilverHawk is a tool in the armament," said Dr. Greg Albaugh, a vascular and endovascular surgeon who practices at St. John's Regional Medical Center in Oxnard. "Every case you look at, you try to do something with an endovascular (minimally invasive) approach first."

The downside, he said, is that the benefits won't last as long as a bypass would. But it could postpone the need for a bypass, extending the person's treatment options, he said.

"You want to put off the bypass as long as you can," he said. "The disease never goes away."