critical limb ischemia Archives - ACI MedicalACI Medical

Endothelial Activation is Central to Collateral Artery Growth in PAD Patients

Collateral artery growth is possible for patients with critical limb ischemia with the use of external pneumatic compression therapy. Many vascular specialists are skeptical of this notion because it sounds contradictory: how can a completely non-invasive treatment improve microvascular circulation to the point that the limb is saved?

Efficacy lies in the activation of the endothelium by way of exerting shear stress on the vessel.

Vascular specialists have good reason to be wary of most compression pumps claiming to promote better circulation and limb salvage. This is because the developers of such pumps did not design their systems with the endothelium in mind, preferring instead to modify lymphedema pumps or DVT prophylaxes to exert more pressure on the patient’s limb at slow compression and decompression rates (two or more seconds). Little clinical evidence exists to support this technique and little thought was put into this type of system’s design for arterial disease treatment. Furthermore, with such compression pumps, little or no pressure is applied to the foot or watershed areas, limiting cutaneous blood flow in these regions.

Now, for the endothelium. When shear stress is exerted on a vessel, its inner lining naturally secretes vasodilators and anticoagulants such as nitric oxide and TcPO2. In effect, the vessel temporarily widens, allowing more inflow. This effect can only be achieved with rapid external compression and decompression (each less than 0.5 seconds). Over time, the daily application of shear stress will encourage the growth of existing collateral arteries, as seen below:

angiogram van bemmelen artassist arterial pump technology

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

The ArtAssist® device is the only external pneumatic compression pump designed to focus on collateral artery growth. It activates the endothelium with rapid compression and decompression rates in the foot, ankle, and calf regions. This addresses poor circulation and wounds present from heel to toe, as well as in the rest of the limb.

Acquiring an ArtAssist® device is simple and may be reimbursed by insurance in certain areas of the United States. Device technology experts can discuss medical benefits with both physicians and patients, and will also fulfill orders. Call or email ACI Medical to begin: toll free (888) 453-4356 or info@acimedical.com.

ArtAssist Device collateral artery growth

The ArtAssist® device is available in the US and internationally.

May 29, 2014 By acimedical ArtAssist®...The Arterial Assist Device®

ACI Medical to Exhibit at VEITHsymposium ™ in November 2013

ACI Medical will be joining VEITHsymposium ™ as an exhibitor this year. VEITHsymposium ™ is one of the largest gatherings of vascular specialists in the US. If you would like to visit the ACI Medical booth at the meeting, we will only be exhibiting for one day.

WOUNDS Exhibit
Tuesday, November 19 in the South Corridor, 2nd Floor
Booth #406

VEITHsymposium ™ is scheduled from Tuesday, November 19 through Saturday, November 23. During this time, vascular specialists from around the world will be giving hundreds of short presentations on the latest advances in vascular medicine.

On Thursday, November 21 at 4:21 PM, Professor Andrew N. Nicolaides is scheduled to present on ArtAssist®…The Arterial Assist Device® and what it can do to medically treat critical limb ischemia.

Use of the ArtAssist® device in the treatment of CLI: How does it work and when should it be used

andrew nicolaides veithsymposium presenter

Prof. Andrew N. Nicolaides

Professor Nicolaides is one of the foremost experts on the relatively new arterial pump technology. Nicolaides was part of a team that evaluated and optimized the ArtAssist® device to maximize circulation. Since having laid the groundwork for this medical device, the ArtAssist® device has been shown in many clinical trials to facilitate wound healing and limb salvage by effectively doubling and tripling blood flow.

ArtAssist®…The Arterial Assist Device®

For discussions and questions prior to and after Professor Nicolaides’ presentation, ACI Medical welcomes you to visit our booth. As the pioneers of the most advanced arterial pump technology to date, ACI will be able to go into depth with you about the science and engineering behind the ArtAssist® device.

Aug 12, 2013 By acimedical ACI Medical, ArtAssist®...The Arterial Assist Device®

Abstract: “How The ArtAssist Pneumatic Compression Device Can Heal Ulcers From CLI & Relieve Rest Pain Noninvasively”

The abstract “How The ArtAssist Pneumatic Compression Device Can Heal Ulcers From Critical Limb Ischemia And Relieve Rest Pain Noninvasively” presented by Prof. Andrew Nicolaides, MS, FRCS at VEITHsymposium 2012 is now available for download from the VEITHsymposium website. We have also included it on our References/Clinical Studies page.

Enjoy! http://www.veithsymposium.org/abstracts/vei/208.pdf

ArtAssist®…The Arterial Assist Device®

Dec 12, 2012 By acimedical ArtAssist®...The Arterial Assist Device®

A modified DVT pump for treating arterial disease? Don’t waste your time.

These days, intermittent pneumatic compression therapy is being used to treat edema, prevent deep vein thrombosis, and, more recently, similar devices have emerged claiming to treat peripheral arterial disease, a serious result of poor circulation in the limbs.

Some device manufacturers will tell you, “Hey, this pump that we use to prevent DVT and reduce edema can ALSO be used to treat arterial disease if you just kick the pressure up a notch.” Or at least they think so. It’s still a compression pump, right? And this DVT/edema/arterial pump will kill two birds with one stone, right? So why not?

The biomedical engineers here at ACI Medical and the vascular surgeons they work with can set this straight: the simple answer is that, since arterial disease and venous disease are inherently different, they should be treated differently.

The companies that just modify lymphedema and DVT pumps and claim these systems can prevent amputations caused by peripheral arterial disease do so without much evidence to back them up. Do their pumps work? Maybe. Is that good enough? Come on.

The team that developed ArtAssist®…the Arterial Assist Device® for ACI Medical approached the arterial pump concept very differently. They realized early on that the new concept of treating peripheral arterial occlusive disease with non-invasive arterial pump compression therapy deserved a lot more thought. With that, they started from scratch and set these goals:

Understand the underlying physiology of increasing arterial blood flow

Design a device based on this understanding

Determine the long-term clinical benefit(s) to patients with critical limb ischemia

Starting in the early 1990’s, ACI Medical’s team of biomedical engineers and vascular surgeons began a thorough progression of research and clinical trials that started with incorporating their most promising findings into the design and function of the ArtAssist® device.

Today, doctors from all around the country (and even some in other countries) prescribe this optimized arterial pump to their non-operable PAD patients because they know how critical it is for threatened limbs to receive optimized therapy that’s been proven to work again and again.

So it’s time for me to put up or shut up – view study abstracts on the ArtAssist® device at this link:

http://acimedical.com/artassist/clinical-studies/

My suggestion: start with the History and Literature Review and our Scientific Brochure.

Then, call ACI Medical at our toll free number (888) 453-4356 or email Don, our Director of Sales & Marketing, at info@acimedical.com to talk to a real, live expert.

Sep 25, 2012 By acimedical ArtAssist®...The Arterial Assist Device®, PAD

Don’t wait around for insurance to save your leg! – Mark H. in Brattle Boro, VT

Mark has been using the ArtAssist® device for almost 15 years! We are also glad to report that his device has saved his left leg from amputation not once, but twice.

Here is Mark’s letter to us:

“Out of many therapies I tried to heal my ulcer, the ArtAssist device was clearly the most effective. Other treatments generally require a certain amount of circulation to the ulcer, while the ArtAssist device addresses the underlying problem by restoring the blood flow necessary for healing.
I quickly started renting the ArtAssist device and then worried about insurance. If I had waited for insurance approval, I’m convinced I would have lost my leg below the knee – a tremendous expense which they WOULD pay for!”
– Mark H., Brattle Boro, VT

We’re with you on the insurance issue, Mark! For years, ACI Medical has been working to get the ArtAssist® device reimbursed by Medicare and other health insurance providers as a treatment that’s WAY less expensive than amputation.

Clinical studies (including a randomized controlled trial) show that ArtAssist® device therapy is 86%-94% effective at preventing the amputation of limbs that are critically ischemic. This is because the ArtAssist® device was specifically designed to increase arterial blood flow to the lower extremities, providing the nutrients and oxygen necessary to promote healing.

The ArtAssist® device is especially useful for patients who, for some reason, cannot have bypass surgery to restore blood flow.

It is recommended that doctors prescribe ArtAssist® device therapy for their patients 1 hour TID for 90 days and send it along with their patients’ contact information to ACI Medical, where they can also talk to experts on Arterial Pump Technology:

Fax: (760) 744-4401
Email: info@acimedical.com
Toll Free: (888) 453-4356

Aug 25, 2012 By acimedical ArtAssist®...The Arterial Assist Device®

The ArtAssist® device presented by Dr. Sherif Sultan of the Western Vascular Institute

Dr. Sultan is a consultant vascular and endovascular surgeon who has been studying the ArtAssist® device in a clinical setting at his practice in Galway, Ireland.

An excerpt from his presentation at the 2009 Veith Symposium in New York (note that this is before the final results of this ongoing study were released):

Art-Assist SCBD is a valuable tool in the armamentarium for dealing with CLI patients with un-reconstructable PVD. It gives superior limb salvage, ameliorates amputation free survival, enhances ulcer healing rates, reduces length of hospital stay and provides rapid relief of rest pain without any intervention in patients with limited life expectancy.

http://www.veithsymposium.org/pdf/vei/2852.pdf

On a related note, Dr. Sultan’s website features a short video about the ArtAssist® device.

For those in Ireland, the ArtAssist® device is distributed by Deprimo, Ltd. (http://deprimo.ie/)

Aug 16, 2012 By acimedical ArtAssist®...The Arterial Assist Device®, PAD

More research into the cost of lower-limb amputation

Recently, while summarizing key studies for a history and literature review that I’m working on, I was reminded that this particular study (the abstract is below) also included comparative costs.

In this case, you will see that although SCBD (in other words, ArtAssist®) therapy doesn’t exactly come cheap, it’s still less than half the average cost of a primary amputation.

Want to hear even better news? This study yielded an 88% limb salvage rate, even after 18 months. Fancy that.

Edit: A 3-month rental of the ArtAssist® device in the United States is more than 36 times less expensive than the cost of primary amputation per patient, according to the following study. And even if you take the SCBD patient cost (below), it still sounds like a better deal to me.

Nonoperative Active Management of Critical Limb Ischemia: Initial Experience Using a Sequential Compression Biomechanical Device for Limb Salvage

Sherif Sultan; Olubunmi Esan; Anne Fahy

Department of Vascular and Endovascular Surgery, Western Vascular Institute, University College Hospital Galway, Galway, Ireland

Vascular 2008;163:130-139

Critical limb ischemia CLI patients are at high risk of primary amputation. Using a sequential compression biomechanical device SCBD represents a nonoperative option in threatened limbs. We aimed to determine the outcome of using SCBD in amputation-bound nonreconstructable CLI patients regarding limb salvage and 90-day mortality.

Thirty-five patients with 39 critically ischemic limbs rest pain = 12, tissue loss = 27 presented over 24 months. Thirty patients had nonreconstructable arterial outflow vessels, and five were inoperable owing to severe comorbidity scores. All were Rutherford classification 4 or 5 with multilevel disease. All underwent a 12-week treatment protocol and received the best medical treatment.

The mean follow-up was 10 months SD ± 6 months. There were four amputations, with an 18-month cumulative limb salvage rate of 88% standard error [SE] ± 7.62%. Ninety-day mortality was zero. Mean toe pressures increased from 38.2 to 67 mmHg SD ± 33.7, 95% confidence interval [CI] 55 – 79. Popliteal artery flow velocity increased from 45 to 47.9 cm/s 95% CI 35.9 – 59.7. Cumulative survival at 12 months was 81.2% SE ± 11.1 for SCBD, compared with 69.2% in the control group SE ± 12.8% p = .4, hazards ratio = 0.58, 95% CI 0.15 – 2.32. The mean total cost of primary amputation per patient is €29,815 ($44,000) in comparison with €13,9000 ($20,515) for SCBD patients.

SCBD enhances limb salvage and reduces length of hospital stay, nonoperatively, in patients with nonreconstructable vessels.

via ACI Medical – ArtAssist® Device.

Mar 14, 2012 By acimedical ACI Medical, Health