DeGroat Performs Birmingham’s First Shockwave Javelin Procedure

By Laura Freeman

Blocked veins steal legs and lives. Aching, burning pain can be unrelenting, and devastating wounds may develop and never heal.

While medical advances have brought a variety of treatments for restricted circulation in legs and thighs, one barrier has persisted: to be successful, most therapies need at least some access to the vein. In patients with Peripheral Artery Disease (PAD), severely calcified plaques can create a 100 percent blockage that previously has been difficult or impossible to open. The only choice was taking the risks of an open surgery procedure or doing nothing.

Either choice comes with the possibility of complications, especially in patients with diabetes and other chronic conditions that make them more prone to both blockages and adverse surgical outcomes.

Now a new sonic tool is giving interventional cardiologists a way to break through the problem much like sound waves are used to break up kidney stones.

“When we’re working on restoring circulation in the legs and thighs, and we come to a 100 percent blockage that even a wire can’t get through, intravascular lithotripsy can often fracture the calcified plaque to open the veins enough for further treatment,” interventional cardiologist Christopher DeGroat, MD of UAB St. Vincent’s said.

DeGroat and his PAD team were the first in Birmingham to use this innovative approach to open blocked vessels. In several advanced cases with 100 percent blockage, they have focused acoustic waves produced by Shockwave Medical’s Javelin like a sonic chisel to fracture obstructions to help patients with chronic limb-threatening ischemia (CLTI) avoid the need for amputation.

“It’s the first non-balloon platform for expanding narrowed vessels. The catheter is tipped with a tool that produces pulsing sound waves in a spherical energy field. We position it to chip away the blockage so we can do what is necessary to restore circulation,” DeGroat said. “The goal is safer, more effective care for better outcomes.”

Used for lesions both above and below the knee, the Javelin peripheral intravascular lithotripsy catheter can be advanced while it is delivering energy. The forward delivery mechanism is designed for difficult to cross lesions where standard devices may not work. Since it doesn’t use a balloon, it can help to minimize complications like dissection.

The procedure can be done with conscious sedation, which may be safer for patients with chronic conditions that make general anesthesia a higher risk. About 80 percent of patients can go home the same night.

“How long the procedure takes and how long the results last tend to vary from patient to patient,” DeGroat said. “In simple cases, we may be out of the cath lab in an hour. Where there is a lot of work to be done, it could take up to five hours.

“The procedure can greatly improve symptoms, but how long that relief lasts depends on what happens after the procedure. If the patient does cardiac rehab and a lot of walking, keeps blood sugar under control, and stops smoking, the outlook is good. If not, we are likely to see symptoms returning all too soon.”

Restoring circulation can dramatically improve quality of life. In addition to getting around better and being able to do more, the easing of relentless pain can be a tremendous relief.

Without intervention to restore circulation, problems tend to increase and take a serious turn for the worst. Wounds may develop and progress into huge lesions that can become septic. Eventually, patients may have to choose between the amputation of toes, feet, or legs and losing their lives. Even with such a drastic intervention, the loss of a leg has been associated with a negative effect on life expectancy.

“Not every patient will have such a severe blockage,” DeGroat said. “I often perform a variety of interventions before the problem gets that bad. But when we run into veins that we can’t get through with other measures, this new technology gives us something we can do. I’ve been finding it very helpful in more severe cases.

“However, I remind patients who are showing early signs of circulation problems, the best procedure is no procedure. It’s worth making an effort to do what you can to slow the progression of PAD. Walk as much as you can. Do everything possible to keep you blood sugar under control. Most of all, if you smoke, stop. It could make a world of difference in your life.”