Revealed: new twist to clogged arteries

A REMARKABLE discovery by Scottish doctors is set to give a new lease of life to millions of people with clogged arteries.

Until recently it was assumed blood flowed in a straight line but recent research north of the Border has revealed that it ‘corkscrews’ as it travels through the body.

That simple but profound revelation has led to the creation of revolutionary artificial implants that promise to transform both the lives and survival prospects of patients with blocked arteries.

A team at Ninewells Hospital in Dundee have developed artificial arteries that force blood to corkscrew as it flows, cleaning away potential blockages and significantly cutting the patients’ risk of limb amputation and death.

The breakthrough began when Peter Stonebridge, a consultant at the hospital, put a tiny camera inside an artery and noticed the blood was rotating while moving forward. He and colleagues Graeme Houston and John Dick, who treat hundreds of people each year with arteries narrowed by disease, then set out to discover if this spiral flow gave natural arteries any advantages.

Experiments showed that it greatly reduced turbulence and smoothed the passage of blood. That, in turn, is thought to slow down the process by which arteries become blocked because of a build-up of fatty deposits inside them.

Such clogging, which is present to some extent in 90% of adult Scots, is a leading cause of heart attacks and strokes, which kill about 19,000 people each year north of the Border.

It is also a common cause of limb amputations following loss of circulation, and it results in about 1,500 hospital operations per year.

It is often treated by bypassing problem areas using an artificial artery made from plastic, which is grafted on to the existing blood supply in a "bypass" operation. Another technique involves inserting tiny metal scaffolds into arteries which physically maintain the vessels’ correct cylindrical shape.

But blood passing through the artificial inserts does not "corkscrew" as it does in natural arteries, and it is thought that is a key reason why many clog up again after operations.

In some areas, such as bypasses below the knee, seven out of 10 synthetic grafts will fail within two years, and 40% of patients will have to have a limb amputated as a result. Others face repeat bypass surgery. Both problems can shorten life expectancy.

Tayside Flow Technologies (TFT), a spin-off company founded by the three doctors, has now developed artificial arteries whose shape encourages natural spiral flow. Made from plastic or aluminium, they have a design similar to the bore of a rifle which preserves the spinning motion of the human artery. Although not yet tested in humans, it is thought they could halve the current failure rate. That could save hundreds of lives in Scotland each year and millions worldwide.

TFT has now won 1.3m in investment to carry out trials in patients.

Houston, a vascular surgeon, said: "We have a great deal of difficulty counselling patients on the subject of devices that really don’t work very well. There’s a very high failure rate, and a very high loss-of-limb rate.

"We probably see 300 people a year in Tayside who need these operations on their legs alone, so the potential to improve is really quite significant."

He added: "The Eureka moment with this technology came when we discussed with the physicists at Dundee University what we had observed in terms of spiral blood flow.

"They pointed out that blood flowing in a simple tube should not behave like that, so there must be a reason for it. That crystallised it in our minds that this was really worth chasing down."

The Ninewells doctors believe the body has evolved spiral blood flow specifically to avoid arteries clogging.

The corkscrew motion appears to be started by the heart itself, which pumps out blood in a vortex, and is maintained by the design of artery walls.

TFT chief executive Antony O’Dell said: "By using these devices it shouldn’t take too long to see a substantial improvement in terms of patients. Amputation is the main problem for them at the moment. Quality of life takes a big hit when that happens and it’s very difficult for them to manage, particularly if they’re elderly."

Bob Crilly, 68, had a quadruple heart bypass nine years ago but has recently suffered angina and been told he may need a repeat operation if his artery grafts have failed.

Crilly, spokesman for the Dicky Ticker patients’ support group in Glasgow, said: "Even if this technology means grafts last only a bit longer that would make a big difference to people like me. We’ve every confidence in the work being done on this in Scotland."

TFT is one of a handful of companies set up as spin-offs directly from the Scottish NHS. Because of Scotland’s tradition of world-class medical research, the area is seen as having major future potential.

Sir Tom Farmer, founder and chairman of tyre-fitting giant Kwik-Fit, is among the investors in TFT.

He said: "This seemed to me to be something with great possibilities and the people involved created a very big impression on me.

"It also demonstrates the need for us all - whether government or investors - to look closely at what is coming out of our hospitals and universities."

'I was prepared to have my leg cut off'

CASE STUDY

MARJORIE Butt asked her doctor to cut her leg off and give her an artificial limb after suffering months of agony caused by clogged arteries.

Butt, 73, has endured 15 months of searing pains in her legs over three years despite repeated surgery to clear the affected blood vessels.

The keen golfer is anxious to be one of the first to try out the new ‘rifle bore’ implants developed by the team at Ninewells Hospital in the hope that it will finally cure her debilitating condition.

"I would try it. I want to get back to playing 18 holes of golf and walking further. I would go for anything that would help me do that," she said.

"I did get to a desperate stage and said I was prepared to have my leg cut off. I thought I would be better with an artificial leg, because I’m an active person and I love golf and walking. Sitting around is not for me."

Butt, who lives in Monifieth in Angus, said that amputation was a "last resort" but that it was still a possibility in her case. She had an artery-bypass operation, but the artificial implant became clogged and she had to have another one fitted.

Butt has also undergone a procedure called angioplasty, which involves inserting a small balloon into the artery, then inflating it to widen the blood vessel. She said this felt like someone was pouring boiling water down her leg.

She explained: "Despite the pain, I was told to keep on walking, which I did. It’s the same now. I’ve got to walk an hour a day.

"It’s a tightening in your leg and it’s sore. What you do then is stop, the blood starts flowing again and you start walking again.

"A walking stick helps a lot, but there is a bit of pride that comes into that. I don’t like to use it too often."