Hewing the Fat

When he began to feel pain, coldness and weakness in his left leg, the 65-year-old amputee recognized all too well the classic symptoms of hardening of the arteries. The disease that had already claimed his right leg was now attacking his left. As a last resort, two young doctors from the New York Downstate Medical Center in Brooklyn suggested trying a new surgical technique that they had only tested on animals and human cadavers. Their method, they said, might save the leg.

The problem the surgeons faced was familiar. An artery consists of two inner layers and a "backup" outer layer which the flowing blood normally never touches. In arteriosclerosis, a fatty substance hardens along the inner layers and clogs the blood flow. The trick is to clean, remove or bypass those inner layers. Surgeons once commonly slit open the artery along the length of the diseased portion and scraped out the offending matter; more recently they have been bypassing or removing the entire section and replacing it with a synthetic graft.

Downstate's Dr. Martin Kaplitt, 26, and Dr. Sol Sobel, 40, offered an operation that was both simpler and quicker than standard techniques. Along with Kings County Hospital's Dr. Philip Sawyer, they clamped off the diseased section at either end, then injected carbon dioxide between the outer and inner layers of the artery. With the two layers thus separated, it was relatively easy to make a small incision and snip off the ends of the diseased inner layers, then pull them out. After the incisions were sutured and the clamps removed, the blood immediately began flowing through the undiseased outer layer. The operation has been tried on various arteries in 14 other patients. Thus far, there have been no complications.

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