Lasers put patients back on their feet
Unblocking arteries can save legs

HOUSTON, Texas, May 23, 2005 – As a college instructor, Robert Ristau knew the value of research in solving serious problems. When pain and fatigue in his legs began slowing his tennis game, Ristau's search for a solution led him to an innovative treatment at Memorial Hermann Hospital.

Oscar Rosales, M.D., medical director of the cardiac catheterization lab at Memorial Hermann Heart & Vascular Institute – Texas Medical Center.

Ristau, 76, has a history of heart problems and is quite familiar with the use of balloons and stents to open blocked blood vessels supplying the heart, a procedure he had already undergone five times. When his doctors identified blocked arteries as the cause of his leg problems, Ristau began looking into similar, minimally invasive treatments.

“I knew I had luck with stents before. They were effective and it didn't require being laid up for a long recovery time,” recalled Ristau, a New Braunfels resident who teaches human resource management at San Antonio College .

Ristau's search brought him to Oscar Rosales, M.D., medical director of the cardiac catheterization lab at Memorial Hermann Heart & Vascular Institute – Texas Medical Center . Rosales was conducting a clinical study on wireless, laser-assisted peripheral angioplasty, an effective approach to opening blocked or collapsed arteries in the legs. The treatment is one of several methods Rosales and his colleagues use to save limbs.

“Losing a leg brings great physical, emotional and psychological consequences,” said Dr. Rosales. “Our study proved this innovative technique can be effective in preventing amputations.”

In laser-assisted angioplasty, the cardiologist makes a small incision in the groin opposite the affected leg and runs a narrow catheter, or tube, across to the blocked artery.

A small laser device is placed on the end of a guide wire and threaded through the tube to the point where the obstruction begins. Energy directed from the laser vaporizes the plaque clogging the artery. The cardiologist gradually extends the laser and repeats the process until the artery is opened and blood flow restored.

After a path is cleared by the laser, Rosales and his team perform balloon angioplasty and place stents as needed to keep the vessel open.

Laser-assisted revascularization can prevent the need for surgery in many cases, but as Dr. Rosales explained, open surgery may still be necessary in severe instances of peripheral artery disease. “Sometimes, you can't even see where the old vessel was. You don't have a path to follow.”

Such was the case with Rosa Gutierrez of Houston, a 68-year-old mother of 10 who experienced blockages in both legs. “I couldn't walk that much. I had to sit down and rest,” Gutierrez recalls. “My legs were just constantly in pain.”

While the laser technique was able to restore adequate blood flow to her left leg, her right leg required surgery. Now that she's back on her feet, she sometimes experiences pain in the right leg but has no complaints about the left one.

Gutierrez is diabetic, a condition that often causes problems with legs and feet, and many of the patients in Rosales' study experienced even more advanced complications.

People with diabetes, chronic high blood pressure or coronary artery disease often develop sores on their legs and feet. Blocked arteries can prevent these ulcers from healing properly, which can lead to amputations.

The trial Dr. Rosales conducted at Memorial Hermann involved 25 patients for whom traditional techniques had failed. Many of them had non-healing ulcers on their legs and feet. Of those studied, 22 avoided amputation, 18 of them without additional surgery.

Follow-up treatment in the Memorial Hermann Wound Care Center plays a vital role in recovery for many patients. “Wound care is essential,” Dr. Rosales stresses. “Sometimes, we prescribe hyperbaric oxygen therapy to speed the healing of ulcers.”

Fortunately, neither Gutierrez nor Ristau developed ulcers, but they could have faced serious consequences if the blocked arteries in their legs had not been properly treated.

The minimally invasive laser technique used by Dr. Rosales gets patients back on their feet within a day or two, and both Gutierrez and Ristau can attest to the long-term effectiveness of the procedure.

“I've had no recurrence of problems in my legs at all,” said Ristau, who underwent the laser procedure three years ago. “I was playing tennis within a week without any discomfort.”

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