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Is funding cut a false saving? – The Irish Times – Tue, Jul 24, 2012

A home device that increases arterial blood flow to the leg can help save patients’ limbs – and taxpayers’ money – so why is it no longer paid for by some HSEs, asks MICHELLE MCDONAGH

EIGHTY SEVEN-year-old Bridget O’Malley has managed to stay in her own home and avoid having a second leg amputated through the use of a cost-effective, non-invasive home device which increases arterial blood flow to the leg. However, she is the only patient in Mayo still receiving HSE funding for the ArtAssist device and one of very few in the country due to funding cuts.

Read the rest via Is funding cut a false saving? – The Irish Times – Tue, Jul 24, 2012.

artassist arterial assist device

ArtAssist®…The Arterial Assist Device®

Diana’s note:  Yep, that’s our ArtAssist® device! As you read the article further, you’ll see another story like Mrs. O’Malley’s, except that Mr. Conneely does not receive financial assistance for his device – he must pay out-of-pocket for it. Stateside, at ACI Medical, we’ve likewise been fighting for Medicare to reimburse for the ArtAssist® device because, as Dr. Sultan states in this article, having a patient on a device instead of undergoing a costly amputation really is “a no-brainer”.

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Andrew Nicolaides scheduled to talk about the ArtAssist® Device at Veith Symposium 2012

We are excited to announce that at this year’s Veith Symposium in New York, Professor Nicolaides will be giving a short presentation about our own ArtAssist® pneumatic compression device.

As one of the ArtAssist® Device’s key developers, Prof. Nicolaides is a veritable expert on the machine’s capability to treat non-surgical patients suffering from severe PAD. If anyone can give a great 5-minute talk about our new technology at 6:46 a.m., it would be him.

Are you attending Veith 2012? Roll out of bed, grab some coffee (or whatever you do to wake up…I don’t judge), get dressed with as much coordination as you can muster, and make your way down to the lecture hall on Friday, November 16 from 6:46 – 6:51 a.m. to listen to “How The Art-Assist Pneumatic Compression Device Can Heal Ulcers From CLI And Relieve Rest Pain Noninvasively.”

As a man of vast knowledge, Prof. Nicolaides will also be presenting on a couple of other topics. Check out his schedule by clicking here.

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The Gift of Limb Salvage: Claire’s Experience with the ArtAssist® Device

“Try it! What do you have to lose except your leg! It’s worth it and there’s absolutely no pain!” – Claire T., Tucson, AZ

ArtAssist Arterial Assist Device

ArtAssist®…The Arterial Assist Device®

As I may have mentioned before, knowing that our product changed someone’s life for the better makes all of our work WORTH IT. Claire’s life as she knew it was about to take a turn for the worse, so when her doctors recommended she try the ArtAssist® Arterial Assist Device®, she jumped at the chance.

Claire and her daughter co-wrote our staff a wonderful letter, chronicling her entire experience:

 

Dear Don and Sylvia,
I am helping to write this letter with my mom (Claire T. / Tucson, Arizona) to give you a little documentation how the ArtAssistDevice has helped to save her leg. Here is the time sequence:

  • My mom had a cadaver artery put in her right leg in order to possibly save her leg. (Advanced PAD disease). This was in March of 2011.
  • In early August, the cadaver artery stopped working because the smaller arteries in my mom’s feet became too narrow. No more surgery could be done. She goes on Vicodin for the pain.
  • Later part of August 2011, Dr. Luis L mentioned that if he could get the device, would she be willing to try it in order to save her leg. She said “YES!”
  • Device arrives on September 6, 2011 and she immediately uses it for 1 hour /3 times a day / 7 days a week. A lot of pain in her right leg. She is sleeping very little because of pain by the end of the second week, there is remarkable improvement. She can walk without pain in her leg for short distances and sleeps for about 4 hours before the pain returns. By the first part of October, she starts to use the device for 4 times a day. We travel to Phoenix for her grandson’s wedding and she is able to attend! Pain in the leg has diminished quite a bit but there is still tingling in the foot and toes.
  • By December, she gets off of pain pills and only takes Tylenol.
  • By the first part of January, the tingling in her toes is gone. She drops the times using the device to 3 times a day.
  • By February, she is walking for about ½ mile every day for about 20 minutes.
  • In March, the Doppler from Dr. Michael L shows her blood flow in that leg has increased quite a bit. She cuts back on the number of times per day to 1 or 2.
  • In late March, she develops a small but deep ulcer on her toe on her right foot. It becomes infected. (Sorry No Pictures. It was too small to show up on my camera) Dr. L is concerned that he might have to amputate it. He tells her to use the machine. She goes back to using it 1 hour 3 times per day. The toe within 2 weeks has improved dramatically so amputation is not discussed any more.
  • In mid June, she has another Doppler. It shows more collaterals being made and something was said that an artery that was previously blocked is no longer and he could use it in a bypass if he had to! The ulcer still has a scab but no longer hurts her.
  • She is currently using the machine for 1 hour/ 3 times per day. She is able to walk ½ mile daily with minimal pain. The pain comes in her calf but only lasts for 1 or 2 minutes and then she starts walking again.
  • If it wasn’t for your machine, the doctors have said she would have lost her leg. We believe this. We have seen it. It is a wonderful gift.

Thank you also for the wonderful customer service. You were always such a big help.

Sincerely,
Claire T.
Evelyn F.

Big thanks to Claire and her daughter for sharing their uplifting story with us!

Claire T. has given this information freely and has been made aware of her rights to the content she has provided via written consent.

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I’m now 89 and still have my limbs – Lorraine K. in Grand Forks, ND

Lorraine K. of Grand Forks, ND was diagnosed with severe PAD. For treatment, she at first received a calf-only pneumatic compression device from her hospital. After using this system for a week, she decided that the pressure was too weak and that she was unsatisfied.

Her doctor at the Mayo Clinic in Rochester, MN, then prescribed ArtAssist®…The Arterial Assist Device® for Lorraine in 2002. She was told to use it 4-6 hours a day. Later that year, Lorraine purchased our pump and began to use it in early 2003. She noticed an immediate difference, saying that ACI Medical’s arterial pump “blew [the calf-only system] out of the water.” Since her purchasing of the ArtAssist® device, Lorraine has sent it back to ACI Medical only once for repairs and uses it faithfully for the prescribed amount of time each day.

Lorraine’s only suggestion for the ACI Medical team is to “get the word out” about the therapy that has helped her so much. Sometimes, we receive thank you letters from Lorraine. So, in that spirit, here is a letter she wrote to Don Kjartanson, our Director of Sales & Marketing:

Dear Don,

I wish to thank you for all the good service you have given me, especially for the new blue cuffs, nice to have some color.

The Dr.’s of Rochester, MN have really been surprised to see how well I’ve been doing with my machine. That’s the only thing that keeps me going. I think I’m in the 11th year so am so happy to have found out about this machine. If anyone wants to write to me, I’ll be happy to hear.

Use my remarks as you wish.

And thanks so very much. I could not afford what you’ve given me.

Keep up the good work.

Sincerely,

Lorraine K.

Diana’s note:  I hope you enjoyed reading Lorraine’s sweet note, because patients like her really put the cherry on top of the cake! Even though we already believe in ArtAssist® Arterial Pump Technology as a way to treat PAD, it’s a great feeling to hear from actual patients who need the device. And that, my friends, is what should drive a marketing department!

Update

Since the above entry was based on a telephone conversation and a greeting card, the customer service team at ACI Medical has been reaching out to patients who wish to share their stories. Since Lorraine always has something to add, we invited her to send us all of her thoughts. Among all of our patients, she is certainly one of the most informed about the ArtAssist® device, as she has been using it for almost 12 years! I hope you enjoy her account of how she went from fearing for her limbs to leading a happy, functional life in her own home.

Q:  When it comes to ACI Medical’s customer service, what stands out to you?

To me it’s the very best, very good service. They have always treated me well, they take an interest in you.

Q:  What would you say to a friend, who was looking for a non-surgical solution for PAD, about the ArtAssist® device?

I would say, go for it you have nothing to lose but the pain, it may take a while to get results, so give it time.

Q:  Who prescribed the ArtAssist® device for you?

My son Alvin went to the libraryand got the Reader’s Digest. This is where I found the ArtAssist advertisement, so I contacted the company. They sent me information, and after reading about the ArtAssist machine I went ahead and ordered it. I am so glad we ran across this article. It’s great.

Further thoughts

In March 28, 1996, I had a history of lower peripheral arterial occlusive disease, which had been long standing. I had a left femoral below the knee popliteal bypass graft, which failed in 1999. I had critical lower extremity occlusive disease and was referred for medical treatment. Dr. has been following me since 2000 for this problem. I had severe bilateral peripheral arterial occlusive disease, right 4th toe ulcer to ischemia, in heels then corroded briuts (?) hypertension. I used antifungal cream, I would get pain in calves & feet at a distance of walking across the room, both lower extremities are equally involved. I was using the ArtAssist pump 3 times a day, 90 minutes each hour, it’s remarkable after 11 to 12 years period of no limb loss has ensued. I maintain my activities of daily living and household duties. I have my own house. My son who is disabled lives with me, which is a big help. Dr. says given my age I am doing remarkable with my disease status. I’m now 89, and still have my limbs.

The ArtAssist compression pump is a therapeutic product, a powerful therapy for increasing blood flow with patients effects are for better than any other and without side effects, this has a unique form of pneumatic compression to the patients with diabetic foot ulcers, intermittent claudication, rest pain or non-surgical candidates, have seen positive results with this new technology.

The ArtAssist is very easy to use and very reliable. I look forward to using it, the compression cuffs are durable and designed to last for months of therapy. I am very lucky to have found something that has helped me so much, and I still have my limbs, the medical Dr.’s did all they could and after I got the ArtAssist device, which they didn’t seem to know anything about this machine, but they were happy for me and that I’m doing so well with it. I always use it 3 times a day. It’s the best. You will never find anything better.

Lorraine K.

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Why ArtAssist® arterial pump therapy is unique

When you think of therapeutic pneumatic compression pumps, what comes to mind? Many might think of lymphedema or DVT prophylaxes, but it is less widely-known that arterial pump compression therapy, if correctly applied, can actually treat severe PAD.

ArtAssist Arterial Assist Device

ArtAssist®…The Arterial Assist Device®

ArtAssist®…The Arterial Assist Device® (Arterial Pump Technology) should not be confused with lymphedema or DVT prevention treatment because the ArtAssist® device solves an entirely different problem:  facilitating arterial blood flow to the places that need it, especially in the legs and feet (there are also cuffs available for arms, though it is somewhat less common).

So, for example, if you have atherosclerosis (hardening of the arteries) of the lower extremity or a diabetic foot ulcer, your problems would not be solved with a lymphedema pump, even if it has been modified to be more powerful. (Side note:  some arterial pump makers advertise that a more powerful lymphedema or DVT pump will effectively treat arterial disease. We at ACI Medical suggest that you ask for their clinical evidence.)

Depending on the nature and severity of your arterial disease, you may be better advised to use the ArtAssist® device. This device was not based on a lymphedema or DVT pump design – rather, the ArtAssist® device was designed by vascular surgeons with the goal of increasing arterial flow for patients with poor leg circulation.

Researchers have discovered that, unlike lymphedema pump technology, the ArtAssist® device promotes what we call arteriogenesis, or collateralization These two synonyms refer to the opening of small collateral arteries that already naturally bypass the obstructed artery. We all have these small collateral arteries, but when the main artery has no blockages, the collateral ones aren’t needed.

angiogram van bemmelen artassist arterial pump technology

Arteriogenesis (or collateralization) explains why patients have long-term results after stopping ArtAssist® device usage

In this case, a person with a blocked artery needs to take action so that blood gets where it needs to be. Sometimes, people make lifestyle changes, such as dieting and exercising. Other times, people take medication to improve blood flow. And in more severe cases, people resort to surgery such as bypass and endovascular procedures (e.g. stenting, angioplasty, etc.).

The problem is that some people exhaust all of those options and vascular surgeons believe they have no other choice but to amputate – but that’s not true! There is actually one last shot at limb salvage for these patients, and that is the ArtAssist® device. In one clinical study, it was shown to have up to a 94% limb salvage rate even after 3.5 years.

Do be advised, though:  no one would ever recommend that you let it get to the point of amputation. As with all diseases, the earlier you solve the problem, the better.

If you or someone you know could use the ArtAssist® device as a non-surgical solution for PAD, please call our toll free number 888-453-4356 and ask to talk to Don or Sylvia. If you contact me (via WordPress, Twitter, Facebook, email, website, etc.), I will refer you to either of the two people I just mentioned as quickly as I can – we know how important limb salvage is.

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He speaks! The inventor of the ArtAssist® device

Please enjoy this video of Ed Arkans, MEng (President of ACI Medical), as he gives you a brief overview of the device that successfully saves the limbs of non-surgical PAD patients:  ArtAssist®…the Arterial Assist Device®

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Compressing the foot and why it’s so important

Why calf-only arterial pumps are missing out

ArtAssist device compression sequence

ArtAssist®…The Arterial Assist Device® Compression Sequence

Calf-only arterial pumps are missing a key component because foot compression is essential to improving circulation in the skin of the foot. Good circulation is vital to the successful healing wounds and ulcers. ACI Medical’s ArtAssist® device went through numerous clinical trials in order to optimize compression therapy for treating peripheral arterial disease of the legs and feet.

Researchers and engineers optimizing the ArtAssist® device not only discovered the importance of compressing the foot in addition to the calf, but they also designed this arterial pump technology to imitate the physiological act of walking as closely as possible.

A bit of background

An early study to determine the physiological effects of  intermittent pneumatic compression therapy focused compression on the calf, foot, and both simultaneously.

Although significant increase in arterial blood flow was recorded for individual compression areas, the simultaneous combination yielded disappointing results because blood was not flowing back to the heart as anticipated.

After the conclusion was drawn that simultaneous compression did not produce the desired augmented blood flow for all tissues below the knee, researchers realized that the answer lay in a time delay. Strong, encompassing foot and ankle compression that boosts foot skin perfusion would come first, followed then by calf compression to amplify popliteal flow.

That magical formulation

In essence, foot/ankle compression + calf compression with time delay = successful emptying of venous blood, resulting in improved circulation.

The optimization study led by K. T. Delis, et. al. determined that this foot, ankle and calf compression sequence, applying 120-140 mmHg at a frequency of 3-4 impulses per minute, “provided the optimum intermittent pneumatic stimulus.”

The next logical step was a prospective randomized controlled trial to solidify the efficacy claims.

And the rest is history…

One example of such a trial studied not only the effects of the previously mentioned IPC method, but also the long-term effects on treated claudicants. The results indicated that treated claudicants still retained their ABI’s and walking benefits one year after the end of IPC application.

Following the numerous physiological and optimization studies for the ArtAssist® device, research facilities continued to explore the possibilities of arteriogenesis, therapy for patients with intermittent claudication, and limb salvage.

The ArtAssist® device is currently the only IPC device with this thorough progression of clinical studies and randomized controlled trials to support its efficacy.

References

  1. Improving Popliteal Artery Flow with Intermittent Pneumatic Foot and Calf Compression.” Delis, K.; Labropoulos, N.; Nicolaides, A.N.; Stansby, G.; and Lumley, J. Irvine Laboratory for Cardiovascular Investigation and Research, Academic Surgical Unit, Imperial College School of Medicine, St. Mary’s Hospital, London, UK.
  2. Enhancing Venous Outflow in the Lower Limb with Intermittent Pneumatic Compression. A Comparative Haemodynamic Analysis on the Effect of Foot vs. Calf vs. Foot and Calf Compression.” Delis, K.T.; Slimani, G.; Hafez, H.M. and Nicolaides, A.N. Irvine Lab for Cardiovascular Investigation and Research, Academic Vascular Unit, Imperial College School of Medicine, St. Mary’s Hospital, London UK. Eur J Vasc Endovasc Surg 19, 250-260; 2000
  3. The Acute Effects of Intermittent Pneumatic Foot and Calf Compression on Popliteal Artery Hemodynamics: A Comparative Study.” Delis, K.T.; Nicolaides, A.N.; Labropoulos, N.; and Stansby, G. Imperial College School of Medicine, St. Mary’s Hospital, London, UK. J Vasc Surg, 2000; 32: 284-92
  4. Intermittent Calf and Foot Compression Increases Lower Extremity Blood Flow.” Eze, A.R.; Comerota, A.J.; Cisek, P.L.; Holland, B.S.; Kerr, R.P.; Veeramasuneni, R.; Comerota, A.J. Jr. Presented at the 24th Annual meeting of the Society for Clinical Vascular Surgery; March 1996. Am J Surg 1996; 172:130-135
  5. Optimum Intermittent Pneumatic Compression Stimulus for Lower-limb Venous Emptying.” Delis, K.T.; Azizi, A.A.; Stevens, R.J.G.; Wolfe, J.H.N.; Nicolaides, A.N. Eur J Vasc Endovasc Surg 19, 261-269 (2000).
  6. Improvement in Walking Ability, Ankle Pressure Indices and Quality of Life in Vascular Claudication Using Intermittent Pneumatic Foot and Calf Compression; A Prospective Randomized Controlled Trial with 1 Year Follow-up.” Delis, K.T.; Nicolaides, A.N.; Cheshire, N.J.W.; and Wolfe, J.H.N. Academic Vascular Surgery, St. Mary’s Hospital, London, UK. Presented at the Vascular Surgical Society of Great Britain & Ireland, Nov. 2000, London Arena.
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Challenge conventions. You may end up saving a limb!

Previously, I posted a whole article about how it’s actually not dangerous to use compression therapy on an ischemic limb. However, that’s not the only misconception that we’ve cleared up at ACI Medical. This article exposes a couple more myths that have been known to float around, and how we’ve found evidence to set the record straight.

Even after some experts dismissed the idea of intermittent pneumatic compression (IPC) as a viable treatment for patients with PAD, the creators and developers of the ArtAssist® device put their theories to the test nonetheless.

Pioneered and developed with vascular surgeons, the ArtAssist® device continues to be the leader in IPC therapy for non-surgical PAD patients with varying levels of severity.

ArtAssist® IPC therapy should not be overlooked or dismissed without having considered the clinical evidence:

in fact, it has both saved limbs and improved patient quality of life.

MYTH: Critically ischemic limbs are maximally vasodilated.

False.

In fact, the ArtAssist® device’s first physiological clinical trial disproves this myth. Even without having been optimized to the extent it is now, the prototype yielded results that suggested transient vasodilation.

Later, in 2005, a study conducted by Professor Labropoulos of SUNY not only confirms the earlier findings, but also suggests that increasing the arteriovenous pressure gradient with foot & calf IPC therapy contributes greatly to significantly increased blood flow in the subjects’ popliteal, gastrocnemial and collateral arteries. Skin blood flow also improved significantly in their findings.

MYTH: The ArtAssist® device is the same as any other arterial pump with similar function.

False.

We encourage you to ask yourself these two important questions when considering other devices which claim to perform as efficaciously as the ArtAssist® device:

1. Is it optimized for arterial disease? And

2. Is there clinical evidence and support for this specific device?

Only the ArtAssist® device satisfies each of these questions with its thorough progression of clinical studies: this device alone has been adjusted and optimized from its initial prototype over the past two decades to effectively treat even the most severe cases of PAD.

  • Physiological
  • Optimization
  • Intermittent Claudication
  • Limb Salvage
  • Critical Limb Ischemia (CLI)
  • Arteriogenesis (Collateralization)

Currently, studies are being conducted to explore the ArtAssist® device’s efficacy for adjunct therapies, such as stem cell treatment and gene expression.

The Bottom Line.

Your patient’s non-reconstructable limb will not wait for hearsay on this form of therapy.

We are here to let you know that therapy with the ArtAssist® device gives patients a dependable option that continues to help non-surgical limbs across the country.

Make the decision that could save your patient from amputation.

References

Augmentation of blood flow in limbs with occlusive arterial disease by intermittent calf compression. Van Bemmelen, P.S.; Mattos, M.A.; Faught, W.E.; Mansour, M.A.; Barkmeier, L.D.; Hodgson, K.J.; Ramsey, D.E.; and Sumner, D.S. Springfield, IL. Journal of Vascular Surgery 1994; 19:1052-8.

Hemodynamic effects of intermittent pneumatic compression in patients with critical limb ischemia. Labropoulos, N.; Leon, L.R.; Bhatti, A.; Melton, S.; Kang, S.S.; Mansour, A.M.; and Borge, M. The Department of Surgery, Loyola University Medical Center, Maywood, IL. Journal of Vascular Surgery, October 2005; Volume 42, Number 4: 710-716

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Building collateral arteries with ArtAssist® device compression therapy

Arteriogenesis:  the key to success

For patients who are surgical candidates, the solution to their arterial obstruction comes as quickly as a surgeon can work.

English: podiatric surgery

English: podiatric surgery (Photo credit: Wikipedia)

However, this means that non-operable patients and their doctors are left to find alternative solutions to improving lower extremity circulation. Drugs and lifestyle changes may work as long as the regimen is maintained, but these may still present problems according to each patient’s case.

Patients who use the ArtAssist® device every day for at least 90 days have developed permanent collateral arteries as a result of therapy.

This solution may be ideal for doctors with patients who have otherwise run out of options. With proven efficacy and consistently high success rates, those with severe PAD get another chance to rebuild and strengthen the collateral arteries in their lower extremities.

The theory

When developers optimized the ArtAssist® device to maximize blood flow to the lower extremities, they realized that, even after having stopped therapy with the device, patients kept their improved circulation. “Why is this?” they asked.

After some educated guessing, Paul van Bemmelen, MD, PhD of Temple University began looking into the hypothesis more closely. This publication (Fig. 1) is the first to have documented a threatened limb before and after four months of ArtAssist® device therapy.

The Rabbit study

In 2007, Dr. van Bemmelen performed another study, this time with a rabbit model. He and his team were able to confirm that intermittent pneumatic compression on the experimental limbs increased the number of angiographical collateral arteries.

How it works

Arteriogenesis, the growth of collateral arteries, can be achieved with a regimen of intermittent pneumatic compression, as we’ve just seen. But what actually happens inside the vessels?

Rapid compression causes shear stress on the endothelial cells. These cells react by releasing nitric oxide (NO), which acts as a vasodilator, and tissue factor pathway inhibitor (TFPI), which acts as an anticoagulant. These two substances ease the path of nutrient-rich blood through the collateral arteries.

Within a month, patients with peripheral arterial disease (PAD) typically begin to see a dramatic increase in arterial blood flow if they use the ArtAssist® device every day.

After about 90 days, the benefits can be visualized in an arteriogram, as seen above. After this point, a patient may be able to discontinue ArtAssist® device therapy.

Obtaining therapy

Both physicians and patients can contact ACI Medical for information and ordering:  toll free (888) 453-4356 or info@acimedical.com

More detailed information can be found at acimedical.com/artassist/order.

References

Angiographic Improvement After Rapid Intermittent Compression Treatment (ArtAssist®) for Small Vessel Obstruction
van Bemmelen, P.; Char, D.; Giron, F; and Ricotta, J.J. Department of Surgery, Division of Vascular Surgery, State University of New York and Stony Brook, NY, USA. Ann Vasc Surg 2003;17:224-228

Long-term Intermittent Compression Increases Arteriographic Collaterals in a Rabbit Model of Femoral Artery Occlusion 
van Bemmelen, P.S.; Choudry, R.G.; Salvatore, M.D.; Goldenberg, B.I.; and Blebea, J. Departments for Surgery, and Pathology, Temple University, Philadelphia, USA.
Eur J Vasc Endovasc Surg 34, 340-346 (2007) 

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All stents fail. So what happens next?

andrew nicolaidesBackground

If you are familiar with the nature of endovascular procedures, you’ll know that eventually, all stents fail. At this point, many vascular surgeons choose to redo the stent, but what if there was a long-term solution?

Andrew N. Nicolaides, Professor Emeritus of the Imperial College of London is among  a group of researchers who have done the most studies with grafted arteriopaths using ArtAssist®…the Arterial Assist Device®, to improve blood flow to the lower extremities. This group discovered that using the ArtAssist® device on patients who had already undergone a successful endovascular procedure enhanced arterial circulation.

New Hypothesis

After having confirmed this discovery, Professor Nicolaides and his team in London are thinking about the next step:  after the arterial stent inevitably fails, the patient now has an alternative to getting another stent. If a patient uses the ArtAssist® device while his stent is still in place, Professor Nicolaides hypothesizes, by the time the stent fails, his artery will be capable of accommodating the same beneficial amount of blood as before, and he will not need to go in for another procedure.

Interview

Now that you have a bit of a background, I’ll let Professor Nicolaides explain it in his own words.

ArtAssist Arterial Assist Device

UPDATE

July 13, 2012:  A veteran researcher of the ArtAssist® device has recently agreed to test Prof. Nicolaides’ hypothesis. Stay tuned for more information!

References

Effects of Intermittent Pneumatic Compression of the Calf and Thigh on Arterial Calf Inflow: A Study of Normals, Claudicants, and Grafted Arteriopaths
Delis, K.T.; Husmann, J.W.; Cheshire, N.J.; and Nicolaides, A.N. Imperial College School of Medicine, St. Mary’s Hospital, London, UK. 
Surgery, 2000, Vol. 129, No. 2, p. 188-195

Enhancing Foot Skin Blood Flux in Peripheral Vascular Disease Using Intermittent Pneumatic Compression: A Controlled Study on Claudicants and Grafted Arteriopaths. Delis, K.T.; Husmann, M.J.W.; Nicolaides, A.N.; Wolfe. J.H., and Cheshire, N.J., Imperial College School Of Medicine, St. Mary’s Hospital, London, UK. World Journal Surgery, 2002 Jul;26(7):861-6

Haemodynamic Effect of Intermittent Pneumatic Compression of the Leg After Infainguinal Arterial Bypass Grafting 
Delis, K.; Husmann, M.;  Szendro, G.; Peter, N.; Wolfe, J.H.; Mansfield, A.O.  Regional Vascular Center, Surgery and Department of Academic Cardiology, St. Mary’s Hospital, Imperial College School of Medicine, London, UK.
Br J Surg 2004;91:429-34

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