Advanced PAD Goes From Deadly to Incidental With This New Therapy

Shockwave lithotripsy, a tried-and-true kidney stone treatment, will also help patients with advanced Peripheral Artery Disease

Andrew Hearn, M.D.
Specialty: Minimally invasive endovascular treatment
Mercy Health

as told to Amy Brownlee

Peripheral Artery Disease (PAD) is a dangerous condition. It presents with leg pain and is often mistaken as arthritis. PAD is not diagnosed enough—there’s not enough awareness. There’s a constellation of symptoms, including numbness and leg pain. An early symptom is difficulty walking.

Illustration by Coen Pohl

Patients eventually risk losing viability of tissue, which can develop into gangrene or ulcers that won’t heal on the feet. They can have no pulses in their legs, no blood flow. There’s a 50 percent risk of amputation and a 25 percent mortality rate within a year if left untreated. There are 100,000 amputations a year in the United States due to this condition. Our goal is to get patients ambulatory. If you lose your leg, your health status spirals. Patients enter this failure-to-thrive mode.

The three major populations at risk for PAD are those aged 70 and older, diabetics, and smokers. When there is stress on arteries, they get damaged, which allows for deposits of cholesterol plaques. These plaques become calcified and create blockages.

Shockwave lithotripsy uses sound waves. If you have a kidney stone, you’ll have a transmitter placed on your flank, and the sound wave energy goes through your soft tissue and breaks up the stones. The energy doesn’t hurt the soft tissue, but will fracture the calcified plaque. It also opens arteries.

Patients who benefit from this technology are in a more advanced state; their arteries are more calcified and it’s more difficult to treat with traditional tools like balloon angioplasty or stents. We’re able to treat about 90 to 95 percent of our PAD patients with angioplasty or stents. Five to 10 percent of patients come in and their arteries look like bones on a scan. [For them,] angioplasty results in a lot of trauma. You have to inflate their arteries with such high atmospheric pressures. Then their arteries would shut back down in just a couple months. It’s important because this condition is becoming more prevalent. So this is better use of our healthcare dollar, and it avoids amputations. Shockwave lithotripsy addresses the worst of the worst.

We have a gentleman who came in who was in his early 80s and had declined. He was only able to walk from one room to the next due to lack of circulation. He had a 99 percent blockage in the main artery of his leg. It was heavily calcified and the plaque was located near the knee, where we don’t like to use a stent. After shockwave lithotripsy, his quality of life is back. There was immediate response, and tears of joy.

It’s an American innovation: One of the radiologists out of Stanford came up with the idea just a couple years ago. We think that we’re pretty innovative here at Mercy; we’re the second hospital in Ohio to use this technology and the first in Cincinnati.

Shockwave lithotripsy is an outpatient treatment. It takes one to two hours, with a two-hour recovery because of the anesthesia. Patients can get up and do jumping jacks after. They go home with a Band-Aid.

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