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Dr. Barry Weinstock is director of the Vascular Intervention Center, Mid-Florida Cardiology Specialists.

John Cockrell was playing golf when his calf started to tighten up. Unable to move his lower leg and foot, Cockrell was forced to practically drag his leg up the hill and off of the golf green. Despite the discomfort, he didn't take the symptoms very seriously and assumed this strange occurrence to be a one-time instance simply related to aging. But the pain didn't go away and Cockrell continued to suffer for several months. When walking, he had to stop and rest nearly every 15 seconds due to the severe leg pain; this made John's part-time job as a utility inspector very difficult and his daily golf game was no longer an option. Over time, the pain became more and more intense and continued to limit John's daily activities.

After dealing with pain for months, it was time to seek help. Cockrell sought treatment at the Vascular Intervention Center in Mid-Florida and was quickly diagnosed with peripheral artery disease (PAD); a blockage in his artery was not allowing blood flow to his lower leg and foot causing the intense pain. PAD is a vascular disease that restricts or blocks blood flow in the legs. Arterial blockages, or hardening of the arteries, occur when plaque, thrombus (blood clot) or calcium builds up along artery walls. If left untreated, blockages can lead to sores that do not heal or heal slowly, gangrene and even amputation. Furthermore, those suffering from PAD are at increased risk for heart disease, aortic aneurysms and stroke. Therefore, it is important to recognize and treat symptoms early on as well as to evaluate patients for other, related cardiovascular diseases.

PAD affects approximately 12 million people in the United States yet most don't recognize the symptoms and therefore do not seek treatment. Too often patients, much like Cockrell, experience pain and numbness in their legs and ignore symptoms by simply attributing them to old age, arthritis, or other health issues. This oversight and avoidance can lead to serious health complications. Once diagnosed, PAD can often be treated efficiently and effectively.

The main treatment options for PAD include pharmacology, bypass surgery, balloon angioplasty and newer techniques, such as excimer laser ablation, in which plaque is removed from the vessel through a catheter. Laser ablation is a minimally invasive option that provides immediate relief of symptoms and requires less recovery time than bypass surgery. Older non-surgical techniques such as balloon angioplasty have not produced satisfactory long-term results with plaque and debilitating symptoms often return in less than a year. By using excimer laser ablation to remove plaque before performing other techniques such as angioplasty or stenting, a better immediate procedural result can be realized and, more importantly, a longer-term improvement may be achieved.

Cockrell is an active adult who had already spent months suffering and missing opportunities to perfect his golf game. By treating his condition using a minimally invasive approach with Spectranetic's excimer laser, Cockrell was able to enjoy life again in no time.

An excimer or "cool" laser produces pulsed bursts of ultraviolet (UV) light energy that are capable of ablating or vaporizing plaque, thrombus and calcium into tiny particles that are easily absorbed into the blood stream. This energy is transmitted along flexible glass fibers encased in catheters, which can be passed through arteries and veins. The UV light energy is then focused on the blockages that need to be treated.

A small fiberoptic catheter is plugged into the excimer laser unit and advanced to the beginning of the blockage in the artery. When the tip of the catheter reaches the blockage site, it transmits short bursts of "cool" ultraviolet energy through the flexible fibers of the catheter. The ultraviolet energy penetrates the lesion, vaporizing a small portion of the blockage. The laser catheter is then slowly moved through the blockage at less than one millimeter per second as it vaporizes the accumulated build up. Once the blockage is cleared, the catheter is withdrawn and x-ray contrast dye is injected into the patient's blood vessel, allowing the physician to assess the results of the procedure and ensure no significant blockages remain. If necessary, the vessel may be further treated with angioplasty or stenting. Multiple lesions may be treated during the procedure.

Cockrell spent less than two hours undergoing this brief procedure and was discharged the same day. Three days later, he was back where he wanted to be all along — out on the golf course, enjoying the sunshine and his golf game!


Dr. Barry Weinstock is director of the Vascular Intervention Center, Mid-Florida Cardiology Specialists.

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