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HEART SURGERY: ENDARTERECTOMY

Clogged Arteries

Cholesterol and various fats some-times reach excessive levels in the bloodstream. One of the body's responses is to deposit some of the greasy mix on the inside walls of arteries. These deposits build up over time to form large plaques on the vessel walls, a condition known as atherosclerosis. If the buildup gets thick enough, the artery can be blocked off completely, but before this happens a very thin and irregular section of blood flow can lead to blockage by blood clots. When the flow of blood is severely restricted, the cells served by the artery die. When coronary arteries are affected, the result may be a heart attack.

Cleaning the Arteries

The technique of endarterectomy, the reaming out of arteries, was developed to re-move the plaques and reopen clogged vessels. Drs. Philip Sawyer, Martin Kaplitt, and Sol Sobel of the Kings County Hospital in Brooklyn developed gas endarterectomy for use on blocked arteries in the leg, abdomen, and neck. A needle was inserted in the artery, and a jet of carbon dioxide (CO2) was injected at a pressure of eight pounds per square inch. This tore away the lining of the artery as well as the plaques. The vessel could then be opened to remove the plaques. The technique had been successful on about seventy patients when the doctors began to try it on coronary arteries. The first patient was a forty-four-year-old woman who had experienced two heart attacks and had a life expectancy of less than two years. She was placed on a heart-lung machine, her body was cooled to eighty-two degrees Fahrenheit, and her heart was stopped for the surgery. It was successful.

A Safer Technique

In 1967 radiologist Dr. Charles T. Dotter of the University of Oregon Medical School developed a safer and more effective procedure. He inserted a long catheter in the femoral artery in the groin and fed it into the diseased coronary artery. The catheter served as a guide for a second probe that was positioned in the diseased artery at the point of the obstruction and expanded to push the sponge like plaque against the artery wall, restoring circulation. By the end of 1967, some 150 patients had been treated with this technique, which was completely successful about half of the time.