Peripheral Angiography

10/8/2018

Ashley Rivers, M.D.
Eastern New Mexico Medical Group
Cardiovascular Associates

In the past, Roswellians traveled elsewhere for advanced health care. However things are changing. Eastern New Mexico Medical Center has been pursuing a sustained effort to recruit highly qualified specialists and offer services previously not available in Roswell. In 2016 I was recruited to ENMMC and began working as an interventional cardiologist, treats peripheral vascular disease (blocked arteries in the legs) in addition to coronary artery disease.

PVD leads to leg pain on ambulation, and may ultimately lead to amputation due to gangrene from loss of blood flow. the program for the endovascular treatment of PVD at Eastern has grown tremendously over the past 3 years. We work closely with Dr. Jeffrey Ash, a podiatrist at Eastern, to diagnose and treat patients with critical limb ischemia, where there is an imminent threat of amputation due to loss of blood flow into the lower leg.

The quality of peripheral diagnostic angiography now achieved with the new Phillips imaging systems in the cath lab at ENMMC is un-matched, including high-resolution, magnified, digital subtraction angiograms of the small vessels in the foot. High-resolution angiography of the arteries in the foot is the key to identifying and treating blockages in these small vessels. It is quite important to diagnose and treat obstructive disease in the vessels in the foot since studies during the past decade have shown that failure to treat obstruction in the foot can still lead to amputation, even when severe blockages above the foot have been opened.

Frequently, arterial plaque is actually removed before opening an artery with a balloon. Such atherectomy procedures performed at ENMMC include the use of laser catheters, excisional devices such as the TurboHawk, and orbital atherectomy, where an off-set high-speed burr sands off microscopic pieces from the inside of a plaque. Scoring balloons may be used that bite into the plaque, allowing an obstruction to open more readily. Drug coated balloons are used that drive medication into the wall of the artery to reduce the formation of scar tissue.

Another advance at ENMMC has been the acquisition of a high-frequency “hockey stick” ultrasound imaging probe, which facilitates entry into small arteries in the foot, permitting retrograde arterial access. This dramatically increases success, since it is frequently easier to go up the leg arteries from the foot than down the leg from the groin. Every week at ENMMC , severe, often total, blockages of the arteries in the pelvis, thigh, leg and foot are opened and the flow restored, allowing dying tissue to recover and amputation to be avoided.

The Leadership of Eastern New Mexico Medical Center is very excited about the hospital being able to diagnose and treat people with advanced peripheral arterial vascular disease and critical limb ischemia, and reduce the number of amputations performed in New Mexico. Unfortunately the statistic remains that half of the amputations performed in the US are performed on people who have not even had a basic arteriogram.

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