Some diabetic patients faced with losing parts of their legs might receive a reprieve from amputation through the use of a new laser catheter device at Deaconess Medical Center here.


The new device called Clirpath, which is short for cool laser revascularization of peripheral artery therapy, destroys plaque that blocks arteries in the lower legs and restores blood flow, says Jan Schmidlkofer, manager of Deaconess cardiac catheterization laboratory.


Diabetic patients frequently develop vascular disease in their legs, which limits blood flow and can lead to gangrene and chronic nonhealing wounds.


In the first procedures performed here with the new device, Spokane Cardiology PS, of Spokane, used Clirpath four times in late April to treat patients who suffered from chronic, nonhealing wounds, and all four patients wounds healed after they received the treatment, says Dr. Dieter Lubbe, interventional cardiologist at Spokane Cardiology.


Generally, if the reason the wound wasnt healing is lack of blood flow through these arteries, youll see dramatic improvement in healing within weeks, after the procedure is completed, Lubbe says.


Dr. Greg Jones, medical director at Deaconess Regional Hyperbaric Center & Comprehensive Wound Healing Center, says Clirpath employs a catheter thats small enough to travel farther down leg arteries than the catheters used in other parts of the body. The catheter used in Clirpath is put into the body at the femoral artery in the hip and can be worked down arteries well into a patients calf, Jones says. Other such devices are too big to make it very far past the knee.


Below the knee, the main leg artery branches into three narrow, wispy arteries, Jones says. Oftentimes, he says, patients with peripheral vascular disease have blockages in either two or all three of those arteries. Because those arteries are relatively small, a fairly small amount of plaque can stop blood flow, and in many instances, plaque can build up along several centimeters in segments of an artery.


Diabetic patients frequently develop vascular disease faster in their legs than they do in other parts of the body, Jones says. If a diabetic already has coronary-artery disease, he says, Its almost a given they will have disease in their legs.


If the loss of blood leads to gangrene, treatment typically is amputation. Lubbe says a patient with gangrene who undergoes the Clirpath procedure likely still will lose to amputation part of a toe or a small part of a foot, but typically enough of the foot can be saved that the person can still walk on his or her own.


Diabetic patients also might lose sensation in their lower legs and can sustain a chronic wound that otherwise would have been a minor injurya blister on a toe, for example, or an ulcer on a heel. Such wounds often dont heal in diabetic patients, because blood flow is inadequate. Sometimes hyperbaric chamber treatments are used to help a wound heal, but that doesnt always work for those with severe vascular disease.


Lubbe says, however, that those patients who undergo a Clirpath procedure typically can have full use of their feet restored within weeks.


Patients in need of Clirpath treatment often are more than 80 years old and typically are in the advanced stages of diabetes and peripheral vascular disease, Lubbe says. He says a goal of the procedure is to help them remain mobile as the disease advances.


Schmidlkofer says, Were trying to give them good quality of life for the next year or two. They might not live longer than that, but at least they arent living the last year or so dealing with losing their parts.


The Clirpath procedure, however, doesnt work in all cases. Lubbe says that in some patients, blockages that stop blood flowand lead to problems such as gangrene and nonhealing woundsare found in small vessels farther down a patients leg that even the Clirpath catheter cant reach.


Lead extraction


In addition to being used to treat peripheral vascular disease, Clirpath also is being used here to extract from heart muscle electronic leads that had been parts of implanted defibrillators or pacemakers, Schmidlkofer says. Such wires typically include electrodes that monitor heart rate or other heart activity.


A patient who has had several devices implanted over a number of years might have many leads buried in or attached to heart muscle. Some such leads might have tines that stick into heart muscle to hold them in place or have substantial amounts of scar tissue surrounding them.


Schmidlkofer says the leads can be difficult to remove without damaging heart muscle. In extreme cases, she says, patients have undergone open-heart surgery to have such equipment removed.


The cool laser used in Clirpath can be used to free up such leads without damaging heart muscle, she says.


She expects, however, that the device will be used on only about 10 lead extractions a year here.


Clirpath is made by Spectranetics, a Colorado Springs, Colo.-based medical technology developer. Schmidlkofer says Deaconess invested about $180,000 in the technology, and each laser catheter costs about $1,400. She claims only one other medical center in Washington state, the University of Washington Medical Center, is using the technology, and that center uses it only for lead extraction.