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Signs, Symptoms, And Treatments for Peripheral Artery Disease (PAD)

California Heart & Vascular Clinic's Dr. Athar Ansari talks candidly about this disease which impacts 1 in 20 Americans over age 50.

California Heart & Vascular Clinic's Dr. Athar Ansari, who's performed more than 160 cases using the DABRA Laser System, answered questions from a reporter at HealthGuru during Peripheral Artery Disease Month, which is September. He first discusses the signs, symptoms, and conservative treatments available for this disease, which impacts more than 18 million Americans, and more than 200 million people globally. He then goes on to answer the reporter's question:

Q: Describe today’s stages of endovascular/surgical treatments for advanced stages of PAD?

A: Endovascular procedures are a minimally invasive procedure versus an invasive bypass, as it’s less risky, lower cost, and less recovery time. In minimally invasive procedures for treating PAD, we begin with a needle puncture in the leg, insert a sheath, and then insert a wire to navigate the vessels and find the blockage which is limiting blood flow. Sometimes the treatment is as easy as inserting a balloon over-the-wire to push the plaque to the side.


For patients with CTO’s, or Chronic Total Occlusions, meaning blockages that prevent all blood flow through the vessel, and you've tried a wire, but there are side branches with collaterals and you can't find true lumen, and it's possible you will lose a collateral by poking through it or perforating through the vessel wall with the wire, then the DABRA Laser System is my go-to device. The DABRA Laser System, which is an excimer laser, is like a bulldozer and gets me right where I wanted to be to help restore blood flow. It’s the only device that doesn’t require a guidewire to navigate the vessels. It’s my go-to tool where all other devices have failed me. It was FDA cleared last year and since then I've used it on nearly 160 cases to attack that plaque with a greater chance of creating a channel for blood to flow. It saves me a lot of time because the DABRA is a two-in-one because you are creating a channel and performing an atherectomy, which is the physical removal of debris in the artery. With all the devices, this is the only device that I haven't had distal embolization.


Prior to DABRA, if we couldn't get a guidewire through a blockage, we would then try to get around it by going into subintimal territory and stenting. It’s not optimal as it does cause trauma to the vessel and has a high re-occlusion rate of 60% or 70%. It was discovered by a doctor in Leicester, England, who I think found out this was possible by accident in the 90’s. In the early 2000’s it was practiced widely because, you have to remember that, in many cases the patients are desperate, and our goal is limb salvage. Our job is to do what we can to establish flow even if it only lasts a short time. But once again, this has a very high re-occlusion rate and can damage the vessel. We have drug-coated balloons that can reduce that so-called restenosis rate. But it’s almost guaranteed the patient will be back in a year, if not sooner to have the vessel unblocked. If going subintimal doesn’t work, then we consider bypass if the patient is healthy enough. But I find that in these advanced cases we see that can’t be resolved by minimally invasive procedures, we consider a surgical bypass of the disease artery with a graft If the patients aren’t healthy enough to endure an invasive bypass, amputation is only option. But that’s the very last resort. No doctor wants to do this. As, I said our goal is limb salvage. Still, more than 150,000 amputations are performed each year across the country due to complications with PAD. So, it’s important to be aware of the early warning signs.

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