When most of us hear that a friend or family member has needed a stent or angioplasty to clear a blocked blood vessel, it usually has involved a place near the heart, or maybe in the head.
But there is merit to clearing blocked and restricted vessels in other parts of the body, as well – and the Gates Vascular Institute on the Buffalo Medical Corridor is among the places where those possibilities exist.
That’s where Dr. Azher Iqbal comes in.
Iqbal, 52, of Orchard Park, grew up and did his medical training in New York City. He is a section chief of Vascular Interventional Radiology at Buffalo General Hospital and the Vascular Institute. He sits on the institute board and specializes in endovascular management of arterial and venous disease, including treatment of non-healing ulcers.
That’s a mouthful, so perhaps part of his volunteer work explains his job best: He founded and co-chairs the WNY Chapter of the Save a Leg, Save a Life organization.
“It’s a national organization based in Florida,” Iqbal said. “The basic premise was that 50 percent of patients who have amputations get one without a vascular workup or an angiogram. They get it as a ‘treatment.’ ”
In some quarters – including within the regional medical community – the Vascular Interventional Radiology program remains “a well-kept secret, unfortunately,” Iqbal said, even though he has been in Buffalo since the late 1990s.
So Save a Leg, Save a Life is designed to raise awareness?
We found out in Florida that if you get doctors from different specialities and talk about these things, you build informal ties in a referral basis and you can work on patients as a team to drop the amputation rate.
Amputation is not a treatment, it’s a failure of treatment. Patients who undergo amputation have a mortality rate of 50 percent in five years, 50 percent, which is higher than the rates of many cancers. So we’ve got people from about 60 different specialities who meet every other month now. People involved with treatment of infectious disease, people who specialize in the treatment of diabetes, etc.
Q: What is vascular interventional radiology?
A boarded specialty. It deals with image-guided minimally invasive treatment and is primarily endovascular practice, meaning you work inside the blood vessels.
Q: What sort of conditions are you looking at, and are you fixing things or diagnosing things?
We are diagnosing and treating. We get referrals from primary care physicians with patients who have a problem. So we’ll see the patients, make the appropriate diagnosis and treat them as needed.
We treat arterial blockages in the leg and kidneys about one-third of the time. We treat vein reflux disease, or venous insufficiency that can cause tired legs, varicose veins and leg ulcers about one-third of the time, and the rest we do a variety of things, like treatment of uterine fibroids, narrowing of other arteries in the body, and specifically conditions that lead to non-healing ulcers in the legs due to arterial disease. We’re not surgeons, so we do not do bypasses.
Q: You’re probably dealing with a large number of patients who are diabetic.
With the non-healing ulcers, there’s a huge number of patients who are diabetic. Diabetes is on the rise not only across the country but in Western New York, because of lifestyles, obesity. These are the patients who have no other options once they get an ulcer except A, get their blood glucose under control, B, get the appropriate dressing, and C, get the blood down to carry the oxygen and antibiotics. The opening of those vessels allows the blood to get there and to heal.
Q: How long is a procedure to open up a pretty good-sized vessel in the leg?
An hour and a half to four hours.
Q: Can you walk us through the process?
First you gain access through a groin artery. From there, you navigate through the blood vessels to the area of blockages, which could be in the same leg or the other leg. We use an X-ray to magnify instruments. Then the blockage is crossed with a guidewire or other instruments and once you have a rail or guidewire through it, then over the guidewire you can thread different instruments through it to remove plaque, to do angioplasty or add a stent. Then you come out and put a plug into the site where you went in. The patient can get out of bed in about two hours.
Q: Why are there two X-ray machines in the suite?
So you can look at something from top to bottom and side to side at the same time.
Q: When you’re operating on patients, what’s the age range?
Sixteen, 17; one of my last ones was 102. There’s no wounds to recover from because the work is all done through small catheters. So there’s no loneliness, there’s no depression, no pain. So some patients can get up (shortly afterward) and walk.
Q: What sort of reaction to do get?
We get a lot of hugs.