Enhanced Management of Peripheral Artery Disease
Saturday, February 26, 2011
Peripheral artery disease (PAD) is one of the leading causes of disability and limb amputation in the United States, affecting approximately one in 20 Americans over the age of 50. At Shelby Baptist Medical Center in Alabaster, AL, physicians are combating PAD with the development of the Alabama Limb Salvage Center, providing a multidisciplinary approach to PAD management.
Shelby Baptist Medical Center has been providing high-quality cardiology services to residents throughout Central Alabama for the past 26 years. Performing an excess of 6,000 cardiac procedures each year, it has grown to become one of the largest cardiology centers in the area.
“Shelby Baptist Medical Center is unique in that it services a large patient volume, including a large rural referral area just south of Birmingham,” says C. Dale Elliott, M.D., FACC, founding cardiologist at Shelby Baptist Medical Center. “This patient demographic has one of the highest incidence rates of PAD in the country. Through the development of the Alabama Limb Salvage Center, we have been able to better address this debilitating disease.”
A Multidisciplinary Approach to PAD Management
At the Alabama Limb Salvage Center, patients benefit from physicians specializing in a variety of disciplines, including wound healing, interventional cardiology, vascular surgery and endocrinology.
“When I first began planning the Alabama Limb Salvage Center, I visited facilities in Dallas, TX, and Lafayette, LA,” says Dr. Elliott. “I learned that successful management of PAD involves a comprehensive treatment team consisting of an interventional cardiologist who is trained in minimally invasive endovascular procedures, an excellent vascular surgical staff, an on-site wound care center to help with wound healing once blood is restored and an endocrine specialist who monitors the progression of diabetes, which is a leading cause of PAD. At Shelby Baptist Medical Center, all of these specialties are available, so we put them together as a team and developed the Alabama Limb Salvage Center.”
“Employing a multidisciplinary approach to care is a huge step in the right direction for successfully managing PAD,” adds Everitt Simmons, M.D., Co-Medical Director of the Wound Care Center. “By providing access to physicians in multiple specialties, there are a greater number of chances for the disease to be diagnosed at earlier stages, which allows for prompt treatment of the underlying disease rather than a symptom of the disease.”
Partnering With Area Physicians
“PAD has a significant impact on a patient’s quality of life,” says Dr. Elliott. “Patients often write off claudication as a normal sign of aging; however, if not treated, the disease can progress to a point where they are incapacitated, and limb amputation becomes necessary. This has both medical and economical implications, as limb amputation is associated with extremely high mortality rates, exorbitant medical costs and disability.”
To help facilitate early diagnosis of PAD, physicians at the Alabama Limb Salvage Center partner with referring physicians at several sites across Central Alabama using the PADnet device, a device manufactured by BioMedix — a company specializing in software and integrative technologies for the diagnosis and treatment of vascular disease. The PADnet allows primary care physicians and podiatrists to check blood pressure of the leg, toes and arms. The wave forms and absolute pressures are then evaluated and downloaded to a Web-based application. Specialists at the Alabama Limb Salvage Center are able to log in to the website once a day to view information, identifying patients who either have PAD or who need additional diagnostic testing. Results are available to the primary care physician or podiatrist the following business day. The Alabama Limb Salvage Center hopes to eventually have 12 sites throughout the referral area using PADnet.
Patients who have diabetes, are heavy smokers, have elevated cholesterol and triglycerides, or who have symptoms of PAD, such as claudication, are indicated for screening using the PADnet device.
State-of-the-Art Technology
In addition to the use of the PADnet device, the Alabama Limb Salvage Center also offers the latest techniques and technologies for the diagnosis and treatment ofPAD.
Once patients have been identified as needing additional diagnostic testing, a CTA angiogram or traditional angiogram is usually performed to clearly define the underlying vascular structure and their suitability for intervention.
“As a wound care specialist, I am involved both in the diagnosis and treatment of PAD,” says Dr. Simmons. “Many times, wound care specialists will be the initial point of contact for patients who have presented with a nonhealing wound or ulcer that is determined to be vascular in origin. I also see patients who have been identified as necessitating further evaluation due to results of the PADnet screening. Depending on the diagnosis, we often refer the patient to an interventional cardiologist for treatment of PAD. An individualized treatment plan will then be developed to help resolve nonhealing wounds.”
Modalities available through Shelby Baptist Medical Center that help with wound healing include hyperbaric oxygen therapy, various types and styles of dressings and debridement. Additionally, for vascular treatment of PAD in larger arteries, treatment options include balloon angioplasty and stenting.
In recent years, the development of atherectomy devices have allowed for a minimally invasive approach to removing plaque build-up from smaller arteries. Atherectomy devices currently used at the Alabama Limb Salvage Center include the SilverHawk Plaque Excision System and the Diamondback 360° PAD System. Through the use of these devices, patients benefit from an outpatient procedure that greatly lessens postoperative pain and recovery time.
The SilverHawk Plaque Excision System — developed by FoxHollow Technologies, Inc. — contains catheters that can be inserted to remove plaque from the arteries in a minimally invasive fashion. The catheters contain a cutting blade and a packing device that allow for plaque excision and removal. Unlike other techniques that open the artery by boring a hole in the plaque, the SilverHawk Plaque Excision System removes the plaque from the artery, allowing it to return to its normal size.
The Diamondback 360° PAD System — developed by Cardiovascular Systems, Inc. — is also used to treat severe PAD and restore blood flow through the blocked artery. The device contains a burr that rotates at approximately 180,000 RPM. This single-insertion device also removes plaque and calcium build-up from the artery.
“Each year, we see the development of increasingly sophisticated technologies that can be used to treat PAD,” says
Dr. Elliott. “As a result, the treatment outcomes that are achieved with each passing year also improve because of the devices that are available. At the Alabama Limb Salvage Center, we are proud to be on the forefront of technology and utilize all of the devices available to provide patients with successful outcomes.”
For more information, please visit www.alabamalimbsalvagecenter.com.
Enhanced Management of Peripheral Artery Disease
MD News March/April 2011, Birmingham