NEW LASER SURGERY OFFERS HOPE TO THOSE WITH VASCULAR AILMENTS
March 9, 2008
By MICHAEL T. BURKHART
Izzy Lerner and his wife loved to take walks, travel and exercise.
But over the past few months, Lerner had trouble even going half a block. He stopped exercising.
The pain in his legs was just too much to bear.
"It limits our lifestyle," said Lerner's wife of 51 years, Joan. "He's uncomfortable with all this pain."
Peripheral vascular disease affects about 12 million Americans, according to officials at Our Lady of Lourdes Medical Center in Camden, where a new laser technique is being used to treat the disease, which restricts blood flow.
More than half of those -- including Lerner -- experience leg pain, numbness or weakness.
Vascular issues tend to focus around the heart, doctors said. But the disease affects other parts of the body, including the legs.
"It's tremendously under diagnosed and under treated," said Dr. Richard Kovach, an interventional cardiologist at Lourdes.
The hospital recently purchased an excimer laser, at the cost of about $200,000. The hardware is contained in a washing machine-sized cart.
The laser can remove plaque buildup, as well as scar tissue leftover from implanted pacemakers and defibrillators, according to Spectranetics, the Colorado manufacturer. Housed in a small, disposable catheter, the business end of the laser uses ultraviolet light to vaporize blockages into tiny particles that are absorbed into the blood stream, reducing complications.
Laser treatment also requires less recovery time than other methods.
"It gives us a chance to help more people with different options than we could before," said Dr. Randy Mintz, a Lourdes interventional cardiologist. "Our goal is to help keep patients active."
About 18 months ago, Lerner, who is retired from the optical business, had a stent put in his right leg in an attempt to improve blood flow. They worked for a time, but he started having problems again.
"I can walk, but the pain starts to come," said Lerner, 75, of Cherry Hill. "It's very, very severe.
"I've had to stop doing what I'm doing," he said. "You become a party pooper in what you can do. I'm looking forward to getting back to normal."
There are some frightening statistics when it comes to treating vessels in the legs, doctors said.
Half the patients who undergo amputations don't have an angiogram, Kovach said. And half of those who have one limb amputated have the other removed within two years.
"To me, that's a shocking statistic," said Kovach. "It's a lack of knowledge of what's available."
In the past, balloon catheters and stents were available to treat clogged veins, but were not always effective, doctors said. Laser surgery vaporizes plaque buildup into nothing bigger than a red blood cell, instead of pushing it to the side. Lasers also can treat long portions of affected areas.
Surgery of this kind has only recently reached the point where tissue is not heated up by the laser. Bypass surgery on leg veins also can be tricky, especially below the knee where the veins are small. Amputation is also a treatment option.
Often, referrals come from the patient's podiatrist, who are first to notice when something is wrong.
Lerner underwent the procedure about two weeks ago. He and his wife arrived a couple of hours before the procedure.
In the cath lab, Kovach made a small incision in Lerner's upper right thigh. A catheter was inserted, and dye placed in his veins to get a good picture of the buildup, which was on the left side.
From the control room, Lerner's vitals are monitored, as well as the laser's progression. Equipment and drugs that are given are tracked.
The problem area was easily noticeable. The blood flowed through as a trickle as his heart beat.
After that, a wire about one-14,000th of an inch was inserted, which acted as a guide for the laser.
"You need to lay the track," said Jim Moser, regional manager for Spectranetics who was watching the procedure. "And the train follows."
Most surgeries with the laser take under an hour, Kovach said, but they can take longer depending on what's found. Patients usually can go home the same day, after about six hours of bed rest.
Lerner's wife said her husband was uncomfortable and had pain for about four days after the procedure. But he has been up and walking around and hopes to have the technique done on his other leg soon, which will be the telltale of whether the new technique worked.
Doctors said his prognosis is good.