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When arteries in the legs become blocked, severe pain can result from insufficient blood supply to the muscles of the legs. This often results in difficulty with walking, or even outright immobility. The traditional treatment for people who have blocked arteries is angioplasty, with or without the placement of a stent (an implanted device that helps keep the artery open after the angioplasty procedure).

However, when an artery is blocked at a bending point (like the knee or hip), or when the area of plaque is elongated, it is difficult for doctors to perform angioplasty or place a stent. In those cases, bypass surgery has been the only option to improve blood flow and relieve symptoms.

Simon Gorwara, MD, FACC, of Hudson Valley Heart Center, is now using a new, minimally invasive technique that may help patients avoid open surgery and the associated post-surgical discomfort or infection risk.  Success in treating blocked leg arteries by traditional angioplasty and stent placement has been limited by frequent re-narrowing of the treated blood vessels, from months to years later. Dr. Gorwara is using a device called the “Silverhawk Plaque Excision System,” which has been associated with a lower rate of blood vessel re-narrowing than traditional balloon angioplasty or stent. The Silverhawk catheter works like a tiny drill to cut away obstructing plaque within the affected artery. This procedure is performed at Vassar Brothers Medical Center’s Cardiac Catheterization Labs and is done under local anesthesia. The Silverhawk catheter is inserted into an artery and is guided, with x-ray imaging, to the area of blockage. When the Silverhawk is activated, the tip of the catheter opens, exposing a rapidly spinning cutting blade. The device is slowly advanced through the blockage.

As the blade cuts through the plaque, the broken pieces are collected and held in a special chamber in the “nose cone” of the catheter. The procedure continues until the plaque is adequately cleared or the holding chamber is filled. The device can also be withdrawn to empty the holding chamber, and then reinserted to continue treatment.

According to Dr. Gorwara, “this device is another significant advance for the treatment of peripheral vascular disease (PVD) and we are enthusiastic about partnering with Vassar Brothers Medical Center, and their state-of-the-art cardiac catheterization labs.”

“The Silverhawk system allows us to effectively remove long areas of plaque without damaging the blood vessels. This lack of trauma to the arteries significantly reduces the risk of scarring and re-narrowing of the artery following the procedure,” Dr. Gorwara said.

The technique involves only a tiny puncture to access the artery, is essentially pain-free and typically lasts less than two hours. Generally, as an outpatient procedure, most patients are discharged to home on the same day, without admission to the hospital.

Although it is important to realize that not all patients with blocked leg arteries are candidates for this new technology, people with leg or foot ulcers, leg pain at rest or when walking, cold extremities, etc., may be able to benefit from application of the Silverhawk system. “Each patient is different and problems with leg arteries present a unique challenge to the vascular physician in every case,” said Dr. Gorwara.

Simon K. Gorwara, MD, FACC, received his fellowship training in Cardiovascular Disease from SUNY at Stony Brook, L.I., and took an additional fellowship program in Interventional Cardiology from Columbia Presbyterian Medical Center, NY, NY.  Dr. Gorwara has been associated with Hudson Valley Heart Center and Director of its Peripheral Vascular Interventional Program since August, 2001.  The Heart Center is a group of, currently, 21 cardiologists with main offices in Poughkeepsie, NY; Fishkill, NY; New Windsor, NY; Rhinebeck NY, and satellite locations in Modena, NY; New Paltz, NY and Sharon, CT.