Jay Lieberman DPM, FACFAS

Dr. Marvin Steinberg, father of modern podiatric medicine, recommended the use of posterior tibial sympathetic nerve blocks (for among other things) to temporarily improve arterial flow and assist in the healing of ischemic ulcers. Dr. Steinberg understood that the posterior tibial nerve controls 85% of the sympathetic fibers going into the foot. Even a temporary increase in blood flow to the foot could have significant benefits to the patient with mild to moderate compromise of the arterial flow to the foot.

Former late night television host, Johnny Carson, suffered from exercise induced claudication, which occurred predominantly during his daily tennis game. To improve upon his symptoms and better his performance, Mr. Carson underwent an endarterectomy on his limbs. By today�s standards, the use of this procedure for claudicating pain is virtually unheard of. Bypass procedures or stent placement are not usually done until the patient shows signs of gangrene or intractable ischemic ulcers.

PAD patients commonly have other co-morbidities which make them high risk candidates for open or endovascular revascularization procedures.

The instance of long standing patency in these patients is low. For this reason, we continue to search for a non-surgical alternative.

A paper published by Ballotta E, Renon L, Toffano M, Piccoli A, Da Giau G. in The Journal of Vascular Surgery; 2004; 39 (3): Pages 539-546 entitled Patency and Limb Salvage Rates After Distal Revascularization to Unclampable Calcified Outflow Arteries reported patency rates that averaged 84%, 65%, and 52% at one year, three years and five years post surgical for renal patients and 89%, 76% and 69% in non-renal patients at one year, three years and five years. The primary indication for surgery was gangrene (63% of the time a femoral conduit was used, 32% of the time a popliteal conduit was used) non-renal patients.

A second study done in the European Journal of Vascular and Endovascular Surgery entitled Patency and Limb Salvage After Distal Prosthetic Bypass Associated with Vein Cuff and Arteriovenous Fistula, Ducasse E, Chevalier J, Chevier E, Forzy G, Speziale F, Sbarigia E, Fiorani P, Puppinck P., Volume 27; issue 4: Pages 417-422 (April 2004) reported distal prosthetic bypass patencies of 68%, 53% and 44% at one, three and five years.

The ArtAssist device from ACI Medical works by rapidly pumping out venous blood and reducing venous pressure to nearly zero. This results in a greater arterial-to-venous pressure gradient and therefore, more flow.

The rapid inflation and deflation lowers peripheral resistance by stimulating the endothelium with shear stress.  Endothelial cells are known to release substances including nitric oxide (NO) and tissue factor pathway inhibitor (TFPI), which act as vasodilators and anticoagulants.  With use up to 3 or 4 months, collateral arteries are permanently opened in a process called arteriogenesis.  These collaterals naturally bypass obstructed arteries and use of the device is then discontinued.

View ACI Physician Information: Physiological Mechanisms

A significant number of patients come to us with claudication, ischemic pain or slow healing, Wagner Grade I/II wounds without gangrene or significant necrosis.

Please indulge me and read some of the clinical studies and case reports on the ACI medical web site. Start with the first study and work your way up. Determine if there is a place in your practice for this device. Television, newspapers, magazines and the internet are inundating our patients with information about PAD. It behooves us to become better versed on this subject.

The ArtAssist device requires a doctor’s prescription and a rental agreement for your patient. Once the payment method is determined, the device will be shipped to the patient’s home.

The recommended therapy is one hour, three times a day at home. It is very easy for patients to use and requires no clinical assistance. I would welcome your feedback on this device.

DESCRIPTION ACI Medical, LLC, is a biomedical engineering firm engaged in the research, development, manufacture and sale of therapeutic products and technologies for individuals with varying degrees of life-impairing vascular conditions. With 22 years experience in bringing innovative healthcare products to market, ACI is committed to developing, producing and distributing the highest-quality products for patients, consumers and healthcare partners. ACI holds exclusive rights to several U.S. patents that are the foundation of its hallmark device, the ArtAssist®. ArtAssist®... The Arterial Assist Device™ VenAssist®... The Next Generation Compression Device VenaPulse®   APG®... Air Plethysmograph Miniature Diaphragm Pumps Custom Injection Molding

To learn more about ACI Medical and its products and services, visit www.acimedical.com or call toll free at 888-453-4356.