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Minimally invasive catheter-based interventions are increasingly used to treat the estimated eight million Americans with severe blood-vessel blockages in their legs, a painful condition known as lower extremity arterial vascular disease. A new study shows the approach is safe and effective and may now be considered a first-line intervention for all patients—even those with the severe form of the disease associated with risk for amputation.

Published in the September Annals of Surgery, the study was led by a vascular surgery team from the Columbia University Medical Center and Weill Cornell Medical Center campuses of NewYork-Presbyterian Hospital.

Researchers looked at a series of 1,000 catheter-based, or intravascular, interventions—including balloon angioplasty, stenting and atherectomy (a.k.a. rotorooter). They found that the treatment was still effective in nearly 80 percent of patients with claudication—a moderate form of the disease presenting as pain or fatigue with walking—at three years. Among patients with the severe limb-threatening form of the disease with risk of amputation, there was salvage of the limb in 80 percent of patients. Intravascular interventions also had a much reduced risk of complication or death, compared to traditional open surgical bypass.

"Our study presents evidence that intravascular interventions may be considered the first choice for patients with lower extremity vascular disease that does not respond to medication or lifestyle modification," says senior author Dr. K. Craig Kent, chief of vascular surgery at NewYork-Presbyterian Hospital and the Greenberg-Starr Professor of Surgery at Weill Cornell Medical College and professor of surgery at Columbia University College of Physicians and Surgeons.

"We found that the intravascular interventions also had very good durability—close to that of open surgery. For traditional bypass, the most widely cited rate of patency, or lack of blockage, is 80 percent after five years," continues Dr. Kent. "And, for those who need it, re-intervention is an option—something that isn't with a failed bypass. Catheter-based re-interventions are also highly successful, with as many as 70 percent of blockages remaining open after two years."

According to Dr. Kent, future studies will look at the effectiveness of intravascular interventions beyond three years.

The first catheter-based intervention, the balloon angioplasty, was introduced in 1974. The first coronary angioplasty was performed in 1977. Since that time, several other intravascular techniques have been developed, including atherectomy, stents and laser treatment. "Among all the other reasons, patients also prefer catheter-based surgeries because of their greatly reduced discomfort and quicker recovery compared to open bypass," says Dr. Kent.

The study's principal investigator was Dr. Brian G. De Rubertis, a vascular surgery fellow at NewYork-Presbyterian Hospital. Additional co-authors from Weill Cornell Medical College and Columbia University College of Physicians and Surgeons—affiliates of NewYork-Presbyterian Hospital—include Dr. James F. McKinsey, Dr. Roman Nowygrod, Dr. Nicholas J. Morrissey, Dr. Alan Weinberg, Dr. Rabih A. Chaer, Dr. John Karwowski, Dr. Harry L. Bush and Matthew Pierce.

NewYork-Presbyterian Hospital

NewYork-Presbyterian Hospital—based in New York City—is the nation's largest not-for-profit, non-sectarian hospital, with 2,224 beds. It provides state-of-the-art inpatient, ambulatory and preventive care in all areas of medicine at five major centers: NewYork-Presbyterian Hospital/Weill Cornell Medical Center, NewYork-Presbyterian Hospital/Columbia University Medical Center, Morgan Stanley Children's Hospital of NewYork-Presbyterian, NewYork-Presbyterian Hospital/Allen Pavilion and NewYork-Presbyterian Hospital/Westchester Division. One of the largest and most comprehensive health-care institutions in the world, the Hospital is committed to excellence in patient care, research, education and community service. It ranks sixth on U.S.News & World Report's guide to "America's Best Hospitals," has the greatest number of physicians listed in New York magazine's "Best Doctors" issue, and is included among Solucient's top 15 major teaching hospitals. The Hospital has academic affiliations with two of the nation's leading medical colleges: Joan and Sanford I. Weill Medical College of Cornell University and Columbia University College of Physicians and Surgeons.

Weill Cornell Medical College

Cornell University's Medical School located in New York City—is committed to excellence in research, teaching, patient care and the advancement of the art and science of medicine, locally, nationally and globally. Weill Cornell, which is a principal academic affiliate of NewYork-Presbyterian Hospital, offers an innovative curriculum that integrates the teaching of basic and clinical sciences, problem-based learning, office-based preceptorships, and primary care and doctoring courses. Physicians and scientists of Weill Cornell Medical College are engaged in cutting-edge research in such areas as stem cells, genetics and gene therapy, geriatrics, neuroscience, structural biology, cardiovascular medicine, AIDS, obesity, cancer, psychiatry and public health—and continue to delve ever deeper into the molecular basis of disease in an effort to unlock the mysteries behind the human body and the malfunctions that result in serious medical disorders. The Medical College—in its commitment to global health and education—has a strong presence in such places as Qatar, Tanzania, Haiti, Brazil, Germany and Turkey. With the historic Weill Cornell Medical College in Qatar, the Medical School is the first in the U.S. to offer its M.D. degree overseas. Weill Cornell is the birthplace of many medical advances—from the development of the Pap test for cervical cancer to the synthesis of penicillin, the first successful embryo-biopsy pregnancy and birth in the U.S., the world's first clinical trial for gene therapy for Parkinson's disease, and, most recently, the first indication of bone marrow's critical role in tumor growth. For more information, visit www.med.cornell.edu.

Columbia University Medical Center

Columbia University Medical Center provides international leadership in pre-clinical and clinical research, in medical and health sciences education, and in patient care. The medical center trains future leaders and includes the dedicated work of many physicians, scientists, nurses, dentists, and public health professionals at the College of Physicians and Surgeons, the Mailman School of Public Health, the College of Dental Medicine, the School of Nursing, the biomedical departments of the Graduate School of Arts and Sciences, and allied research centers and institutions. For more information, visit www.cumc.columbia.edu.