Arun Kumarasamy, MBA, a renowned specialist in interventional radiology in Frankfurt am Main, enjoys an outstanding reputation within the medical community. With a focus on minimally invasive, catheter-based procedures guided by imaging, he has specialized in particular in the treatment of vascular diseases, including peripheral arterial disease (PAD). His expertise in interventional radiology, a relatively new field of medicine, has contributed to the growing importance of this specialty.
As Chief Physician at the Center of Excellence for the Diagnosis, Treatment, and Prevention of Vascular Diseases at Sachsenhausen Hospital in Frankfurt, Kumarasamy is regarded as an experienced expert in diseases of the vascular system, particularly in interventional angiology, where he is considered one of the pioneers in the treatment of peripheral arterial disease. Interventional radiology has gained importance in recent years, particularly in the gentle and effective treatment of vascular diseases. This discipline uses advanced imaging techniques not only for diagnostic purposes but also for therapeutic interventions.
Dr. Kumarasamy began his career as a resident in radiology and specialized in catheter-based, minimally invasive therapeutic procedures for vascular diseases. Since 2017, Arun Kumarasamy has served as Chief Physician of Interventional Radiology at Sachsenhausen Hospital. In addition to his expertise in radiology, he earned an MBA in International Hospital and Healthcare Management from the Frankfurt School of Finance. This academic degree underscores his comprehensive knowledge of healthcare management and is reflected in the clinic’s well-thought-out organization, characterized by short wait times and excellent patient care.
The department enjoys an international reputation, particularly for the treatment of peripheral arterial occlusive disease—commonly known as intermittent claudication—which the clinic treats at the highest level. Arun Kumarasamy specializes in minimally invasive catheter-based procedures, including rotational atherectomy, balloon angioplasty, and stent implantation to widen narrowed or blocked blood vessels. His precision and expertise are particularly valuable in cases of acute arterial occlusions, where rapid diagnosis and treatment are critical. Approximately 4 to 20 percent of people in Germany suffer from peripheral arterial occlusive disease (PAOD). The prevalence increases with age and is more commonly diagnosed in people over 65. To learn more about this topic, the editorial team at Leading Medicine Guide spoke with Arun Kumarasamy.
Peripheral arterial occlusive disease (PAOD), commonly known as “intermittent claudication,” is a vascular disease that primarily affects the arteries in the legs. This condition leads to a narrowing or blockage of the arteries, thereby impairing blood flow to the legs. The colloquial name “window-shopping disease” stems from a common symptom: pain in the legs that causes those affected to repeatedly pause briefly while walking—much like stopping to look at store windows—to relieve the pain. When blood flow is impaired due to arterial narrowing, the muscles do not receive enough oxygen, which leads to pain.
Peripheral arterial disease (PAD) is caused by a narrowing or blockage of the arteries, which is most often due to atherosclerosis.
Atherosclerosis is the buildup of fat, cholesterol, and other substances on the walls of the arteries, leading to hardening and narrowing. “The first symptoms that affected individuals often notice are pain or cramps in the calf muscles while walking, which are described as sharp or pressing. This pain, also known as ‘intermittent claudication,’ occurs due to reduced blood flow, which does not supply the muscles with enough oxygen. The pain usually subsides at rest and reoccurs when the person starts walking or moving again. However, as blockages worsen, pain may also occur at rest. The so-called water column plays an important role here. The water column is a measure of the pressure the blood must overcome to flow through the arteries. The higher the water column, the greater the pressure, and the more difficult it is for the blood to fight against the resistance of the narrowed or blocked arteries. “The next stage is reached when even minor wounds simply no longer heal or begin to enlarge,” explains Arun Kumarasamy at the beginning of our conversation.
The causes of peripheral artery disease can vary. “The main cause is actually genetic predisposition. People inherit the condition. The remaining 20–30%, which result from atherosclerosis, thrombosis, embolisms, and risk factors such as smoking, diabetes, high blood pressure, and high cholesterol levels, are the areas where we can make adjustments. This means that a smoker can make an effort to quit smoking; one can manage blood sugar, cholesterol, and triglyceride levels; and lead a generally healthy lifestyle, which naturally includes exercise,” Arun Kumarasamy clarifies, adding: “The timeframe in which arteries in humans narrow or even become blocked varies greatly. For example, there is also acute limb ischemia, which is caused very suddenly by a blood clot that blocks the arteries. Then there is chronic limb ischemia, in which the narrowing has developed over a longer period of time. This can take a few years or even decades. During this time, the body compensates for the developing narrowing by creating collateral circulation. As a result, symptoms are only short-lived and the patient hardly notices them.”
Peripheral arterial disease (PAD) is diagnosed through a series of diagnostic procedures aimed at identifying circulatory disorders in the legs.
The doctor often begins with a thorough medical history, during which the patient’s medical history and current symptoms are documented. “It’s important to speak with the patient at length to find out what symptoms they’re experiencing and what their living circumstances are like. This conversation is also crucial because some patients do not experience specific pain symptoms even when the disease is already at an advanced stage. They simply notice, for example, that they can no longer walk long distances. A physical examination follows, during which the doctor looks for abnormalities such as pain when walking or changes in the skin or muscles of the legs,” emphasizes Kumarasamy.
To obtain precise information about blood flow in the legs, non-invasive methods such as Doppler and duplex ultrasound can be used. These ultrasound procedures make it possible to visualize blood flow in the arteries of the legs and identify narrowings or blockages. In addition, measuring blood pressure at various points on the legs and comparing it to the arm can provide clues about circulatory problems. In some cases, an angiography may be performed. In this procedure, a contrast agent is injected into the arteries, and X-rays are used to visualize narrowings or blockages in the blood vessels. In addition, stress tests may be performed, during which the patient walks or runs under medical supervision to observe and evaluate symptoms during physical exertion. The choice of diagnostic procedures is made on a case-by-case basis, based on the patient’s symptoms and the recommendations of the treating physician, to enable an accurate diagnosis.
In interventional radiology, various techniques are used to treat peripheral arterial disease (PAD), including specific procedures such as atherectomy and targeted treatments in the lower leg and foot.
“There are two treatment approaches—the endovascular, or catheter-based, approach, and the surgical approach using a bypass. Generally, we try to resolve the narrowing using the catheter-based option. If that’s not sufficient, surgical measures can be taken. Of course, there is also a conservative approach if the patient has difficulty walking longer distances. In such cases, walking therapy often helps to promote collateral circulation. In principle, I must say—we do not cure the condition; we merely improve quality of life by alleviating the symptoms. “We can reconstruct blood vessels, but we cannot stop the aging process,” says Arun Kumarasamy regarding the initial treatment options.
Minimally invasive procedures play a significant role in the treatment of peripheral arterial disease (PAD) compared to conventional surgical procedures. They offer various potential advantages, particularly in terms of recovery time and long-term outcomes.
Compared to conventional open surgery, minimally invasive procedures are less invasive and gentler on the body. They require only small incisions or punctures in the skin, rather than large cuts, to access the arteries. This significantly reduces the risk of complications such as anesthesia-related risks, infections, blood loss, and postoperative pain. The recovery time after minimally invasive procedures is generally shorter than with traditional surgical procedures. Patients can often be mobilized more quickly and have a shorter hospital stay. This helps them return to their normal activities sooner.
“With the endovascular procedures performed here, we can insert a catheter through a 2-mm puncture site, then reopen blocked vessels and perform the treatment through this small access point. In addition to all the benefits mentioned above, the cosmetic outcome is ultimately much better, and follow-up complications generally do not occur frequently. Theoretically, some of these procedures could also be performed on an outpatient basis in the near future, though this varies from patient to patient,” explains Arun Kumarasamy. By improving blood flow in the affected arteries, symptoms such as pain while walking are alleviated, and the risk of more serious complications, such as tissue loss or amputations, is reduced. However, the choice between minimally invasive procedures and conventional surgical interventions depends on various factors, including the severity of the disease, the location of the arterial narrowing, and the patient’s individual health characteristics.
“We place great emphasis on interdisciplinary collaboration. The days of ‘silo thinking’ are over. You have to work with colleagues from other specialties, which also improves the overall quality of care and treatment strategy for the patient. You have to view it as a whole, like a gear that turns, where you need well-functioning parts that work together,” comments Kumarasamy.
Atherotripsy is a relatively new technology that can be used to treat peripheral arterial disease (PAD).
This method uses sound waves to break up plaque deposits in the arteries, rather than removing them as in conventional procedures. In atherotripsy, a special balloon catheter is inserted into the narrowed or blocked artery. The balloon features integrated lithotripsy elements that generate ultrasound-based sound waves. These sound waves produce brief, controlled pulses that break up the plaque deposits without damaging the surrounding healthy tissue. The goal is to break up the narrowing. Atherotripsy technology is considered a complementary innovation because it offers a non-invasive method for treating PAD by breaking up—rather than removing—the plaque deposits.
“This procedure has been used in other medical fields for some time, and high-frequency ultrasound has previously been used successfully to break up kidney stones, for example. Vascular calcifications can be broken up and shattered in the same way, making the vessel significantly more flexible. The effectiveness of atherotripsy technology in treating PAD is the subject of ongoing research and clinical trials. Early results suggest that this method could be promising for treating plaque deposits and restoring blood flow in the affected arteries. This procedure is certainly not suitable for every location, but it is another option for treating calcified vessels that cannot be treated with an atherectomy.
In recent years, the treatment of peripheral arterial disease (PAD) has made significant progress, offering new hope to patients with this condition.
“Endovascular procedures have established themselves as effective, minimally invasive treatments and have continued to evolve. These techniques reduce the need for extensive surgical interventions and significantly shorten recovery time. In addition, new medications have been developed that specifically target improved blood flow and can slow the progression of the disease. The focus on personalized treatment approaches tailored to individual needs has improved the effectiveness of therapies. Overall, however, the goal is to follow the motto ‘Leave nothing behind,’ which means striving to treat patients without using foreign objects such as stents. Of course, every effort is also made to avoid amputations. This is because there are still too many amputations in Germany, even though other approaches may be possible. There are regions where more amputations are performed because endovascular treatments have not yet become established there as a standardized treatment regimen. More expertise needs to be brought in here, and better education is required. “The requirement for a second opinion before a potential amputation is now firmly established in the guidelines for diabetes care practices and definitely makes sense,” explains Dr. Kumarasamy.
Further breakthroughs may be on the horizon in the near future. The continuous improvement of interventional techniques will further increase the accuracy and efficiency of PAD treatment.
In addition, a greater focus on preventive measures and lifestyle changes could reduce the incidence of PAD and minimize the need for invasive treatments. Continuous advancements in medicine, supported by innovative technologies and a deeper understanding of the disease, open up promising prospects for improved treatment and quality of life for people affected by PAD.
“I think the treatment of lower leg and foot arteries will continue to take center stage, and new technologies such as bioresorbable stents and the treatment of the smallest vessels—such as those in the foot—will once again become a topic of discussion and take on greater prominence. Specialization and subspecialization among physicians will also increase, not only because it is medically necessary, but also because patients are demanding—or rather, expecting—ever more specialized expertise,” said Arun Kumarasamy.
The complexity of the procedures and the need to improve blood flow all the way to the toes require careful planning and expertise on the part of physicians. Despite these challenges, the new therapies hold enormous potential, particularly in terms of the quality of life for those affected. The ability to improve blood flow all the way to the toes can definitely help prevent amputations and maintain patients’ mobility and overall well-being.
In Good Hands at Sachsenhausen Hospital in Frankfurt am Main
“Here in Frankfurt am Main, we perform among the highest number of atherectomies in all of Germany. We’ve specialized in innovative vascular-opening procedures that involve first using a drill to clear a blocked or narrowed vessel, which increases blood flow; we can then insert a balloon, and because we’ve already cleared the vessel with the drill, we can minimize the high pressure caused by the balloon. In any case, this method often helps avoid the need for a stent—that is, a foreign object. We have a high level of expertise in this area at our hospital, and we’ve been able to specialize extensively. In November 2022, I published a new article on a novel lower-leg catheter that improves patients’ condition even further after treatment (https://pubmed.ncbi.nlm.nih.gov/36363551/). To ensure that others can also benefit from our expertise, we operate a training center and share our knowledge—including with the industry, where we evaluate and help develop new products. “Doctors from around the world come to us to participate in training sessions and observe procedures, and occasionally I also travel to other hospitals—most recently to Bangkok. All of this is motivating, a lot of fun, and allows us to be directly involved in the latest developments,” says Arun Kumarasamy, and with these positive outlooks, we conclude our interesting conversation.
Dear Mr. Kumarasamy, thank you very much for this vital information on peripheral arterial disease!
