The Doctor 'Goes' In: Vascular surgeon fixes circulation problems with innovative procedure
WestLife – May 26, 1999

by Jason Stahl

Watching Dr. Curtis Lockhart explain what vascular surgery is all about by using his laptop computer is a little like watching a kid play a cool, new CD- ROM computer game. He is totally absorbed in the process, awed at the visual images which most easily convey to a lay person what blocked arteries and veins look like, and proud of what he and his team at St. John West Shore Hospital have been able to accomplish.

What they have done is improved the circulation of countless patients who, because of age, diet, heredity, high blood pressure or smoking habits, came into the operating room with fatty obstructions within the walls of the blood vessels.

One of the those patients was Cleveland Indians pitcher Steve Reed, who came to Dr. Lockhart in 1998 after experiencing numbness in his pitching hand. An X-ray seen on Lockhart's laptop shows a blood clot in Reed's arm, which had been caused by a previous shoulder injury. The X-ray quickly dissolves into a live-action game against the Minnesota Twins in September 1998, Reed's first after the surgery. Reed is called into the game, faces Paul Molitor and throws a first- pitch strike.

"How about that?" Lockhart said.

Although Lockhart can't capture visual images depicting other patients' improved conditions quite so easily, he is not a shred less proud of their after-surgery bliss.

The patients who come to him have reason to click their heels before and after their visit to the operating room. If they expect to come away with major incisions and scars, they're wrong – endovascular surgery is minimally invasive, which means that instead of an incision there's a needle hole just large enough for the surgeon to insert a tiny tube. Miniature instruments are sent through this tube to clean out blocked vessels, or clot-dissolving medications can be sent directly to the problem area. By Lockhart's description, it's like the perfect crime – you go in and out without anybody ever knowing you were there.

"Not only can we use needles but, in a spilt second, can change gears and use other tools whether we're doing minor or major surgery without any hesitation," Lockhart said.
Miniature ultrasound lenses are also inserted to help the surgeon find and identify lesions with pinpoint accuracy, and to monitor the blockage removal procedure on a computer screen.

The whole procedure is so simple and safe that many can be performed with the patient under local anesthesia. The small needle size means no discomfort and a faster recovery than a patient would get with conventional surgery. Lockhart sees about 10 to 15 patients a day, with the average surgery time lasting 45 minutes. After fixing Reed's problem, Lockhart has almost become the "surgeon of the stars," operating on Oakland A's pitcher Kevin Jarvis who was referred to the Cleveland Endovascular institute at St. John West Shore Hospital.

©1999 Westlife

'Surgeon hits a home run,' solves clot problem for Indians Reed
Health & Fitness – The Plain Dealer – Monday, May 10, 1999

By: Harlan Spector, Plain Dealer Reporter

Dr. Curtis Lockhart pops into the observation room in between vascular surgeries and pulls out a laptop computer. Click. Here's the inside of a blood vessel. Click, here's what a blocked vessel looks like. Click. Here's how we unblock it.

Click. Now, here's a game photo of Cleveland Indians relief pitcher Steve Reed surrounded by teammates. Looks like the doctor mixed a little business and pleasure. But it's all business.

"When he did a split finger (pitch), he couldn't feel the inside of his middle finger," Lockhart explains. "He couldn't feel it (the baseball) coming off his hand.

"The screen goes to video and Reed is facing hitting great Paul Molitor of the Minnesota Twins. It's September 1998 and Reed is set to throw his first game pitch since leaving Lockhart's operating room five days earlier. Nice pitch. Molitor swings and misses.

It was a special moment for Lockhart and his team at the Cleveland Endovascular Institute, which opened last year at St. John West Shore Hospital.

"I still get excited watching it," says imaging specialist Michael Grubb, holding out his arm to show goose bumps.

Frustrated after seeing several specialists about numbness in his pitching hand, Reed came to Lockhart on the recommendation of team orthopedic physician Dr. Lou Keppler, who is Lockhart's brother-in-law. The problem began in Reed's pinkie shortly after he was traded to the Indians last summer, and the numbness had since spread to other fingers. A blood clot was cutting off circulation and he was scared.

"I was definitely worried not only about my career, but life in general," Reed said. "I have two kids and this is major stuff."

The solution was easier than Reed ever imagined. Lockhart finds and removes blockages by sending a tiny guide wire and other mini-instruments into a vessel through a needle hole. The work is possible because of ultrasound technology that enables the surgical team to navigate the circulatory network using images taken from both inside and outside a vessel and displayed on monitors.

In Reed's case, Lockhart cleared the 2-inch clot near his wrist using a clot-dissolving medication sent through a catheter, also known as "Liquid Plumber for the vessels." In other patients, Lockhart can use angioplasty to open up a vessel or implant a permanent stent – all done through a needle-hole opening and umpteen feet of guide wire and tubing.

Lockhart sees many patients with clots caused by trauma. Reed's clot, for example, came from a previous shoulder injury and worked its way down his arm.

But a big segment of business comes from those who have obstructions caused by plaque or fatty deposits, known as atherosclerosis, a form of arteriosclerosis and the most common vascular disorder.

Risk Factors
Vascular disease is the No. 1 killer in most of the Western world. Common risk factors are smoking, high blood pressure, obesity, high cholesterol and family history of heart or vascular disease.

Atherosclerosis often causes chronic leg pain that afflicts about 2 million Americans. The intravascular ultrasound can detect atherosclerosis in its earliest stages. Bypass surgery was once a common treatment. With less invasive methods, patients are under local anesthesia and can sometimes go home in a few hours.

Lockhart's second major-league operation came in April after another physician referred Oakland A's pitcher Kevin Jarvis to the institute. Jarvis, who also had a blockage of blood vessels to his pitching hand, had his surgery when the A's were in Cleveland. "Our goal is to be on the cutting edge of every vascular technology and tool out there," said Lockhart.
"It's fun. It's enjoyable to have an effect on people that's positive," he said.

©1999 The Plain Dealer