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Researchers study failed stents for peripheral artery disease

Image with caption: Donna Woodworth (left), a retired nurse who also is a study participant, talks with Jason MacTaggart, M.D., during a clinic appointment.

Donna Woodworth (left), a retired nurse who also is a study participant, talks with Jason MacTaggart, M.D., during a clinic appointment.

Researchers at UNMC have received a five-year, $3.5 million grant funded by the National Institutes of Health to find out why stents don't work well for treating peripheral artery disease (PAD).

In the last decade, there's been an explosion in treating PAD using angioplasty and stenting -- a minimally invasive procedure in which the patient is awake and usually leaves the hospital the next day.

Stents, small tubular metal devices that doctors put in diseased arteries to keep them open, work well in the heart, but often fail miserably in the leg arteries. Though peripheral artery disease stents may generally work for many patients, there is significant room for improvement as many patients require repeat procedures in as little as one or two years, said Jason MacTaggart, M.D. A national study estimated the cost at $21 billion a year.

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Part of the research team at work: Right to left: Jason MacTaggart, M.D., Alexey Kamenskiy, Ph.D., and Paul Deegan, research associate and mechanical engineer.
Dr. MacTaggart, a vascular surgeon, and Alexey Kamenskiy, Ph.D., a biomedical engineer, both assistant professors in the UNMC Department of Surgery, are co-principal investigators of the research study.

"There are several ways to treat PAD, but none of them are really very good," Dr. MacTaggart said. "It's frustrating for doctors and patients. Everybody is trying to build a better mouse trap, but nobody really has. With the support of the UNMC Department of Surgery and our team of collaborators, we are taking a rational approach to figure out why stents don't work very well in the legs."

Researchers will study donor cadavers and arteries of various ages and stages of disease to gain accurate information to design computer models that would be used to determine which stent is best to use in individual patients. The computer predictions will be verified in PAD patients receiving stents at Nebraska Medicine, UNMC's hospital partner, and the VA Medical Center.

"Our goal is to help make better stents and to personalize PAD interventions. We analyze how these stents go into the artery, how they interact with the arterial wall as we walk, and how to make this interaction more favorable," Dr. Kamenskiy said. "Right now there's a lot of art to using stents in PAD. We are trying to do less art and more science."

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Several types of stents used in peripheral artery disease.
Peripheral artery disease reduces or completely cuts off blood flow in the leg arteries. This results in pain, numbness of the feet, inability to walk, wounds that won't heal, and, in worse case scenarios, amputation of the toes, feet or legs. The risk factors include diabetes, smoking, high blood pressure, high cholesterol, obesity, and aging.

For more information, contact Karen Taylor at UNMC at (402) 559-3935 or Holly DeSpiegelaere at the VA, (402) 995-4171.

Organ, tissue donors help advance science

According to the U.S. Centers for Disease Control and Prevention, about 8 million people in the U.S. have PAD, including 12 to 20 percent of individuals older than age 60.

Jason MacTaggart, M.D., a vascular surgeon, and Alexey Kamenskiy, Ph.D., a biomedical engineer, said they are able to approach the problem in a unique way because of those who have donated their bodies to science and organ donors who have said yes to tissue donation.

"It's a very important thing," Dr. MacTaggart said. "We are grateful to donors and their families and to the Nebraska Organ Recovery System. If someone donates their heart or liver, they help one person. If someone donates their arteries to research, they are potentially helping millions of people. There is no replacement for human tissues in science. If we don't have human tissues to study, we're severely hampered in advancing discoveries in medicine and surgery."

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