As the field of his specialty suggests, Helena cardiologist Richard Paustian has spent most of his career working on and around his patients' hearts.

But that's starting to change. Over the past several years, a new surgical technique is helping people who suffer from peripheral arterial disease (PAD), or plaque blockages of arteries in lower extremities.

There aren't always symptoms, but when there are, people suffering from PAD experience pain in their legs, typically from the lack of blood flow, and often can walk only very short distances before that pain becomes unbearable.

In the past, amputation was a standard response. But recently, doctors have practiced a technique that allows them to remove plaque from the arteries without so much as fully anesthetizing the patients or admitting them to the hospital overnight.

";The technology that's been used in hearts has now been applied to legs," Paustian said. The technique was first approved in 2003 and has become increasingly popular since then.

So a few years ago, Paustian began attending classes to learn how to use his existing skills on a new part of a patient's anatomy.

";It sounds like it's all the same technology, and in many respects it is, but the techniques are different," Paustian said.

Using a tool developed by SilverHawk, Paustian can scrape the plaque from the walls of femoral arteries, allowing blood to flow smoothly again.

";And once the normal pathway of blood flow is restored, (the pain) just goes away," Paustian said.

From an incision near the groin, Paustian inserts a wire that can be routed into the blocked vessel. Then the tool is fed into the body over the wire to the scene of the blockage. Its cutting blade scrapes away plaque, which is then caught ";upstream" in a device resembling a mesh net, then removed from the body. Sometimes there's just one blockage, while in other cases Paustian will remove plaque from several sites in a single artery.

It's similar to the techniques used to remove plaque and place stents in arteries around the heart, although the leg arteries are much wider, Paustian said. Whereas a heart artery might be between 2.5 and 3.5 millimeters across, the thigh arteries that are cleansed for peripheral arterial disease are closer to 5 or 7 millimeters.

Paustian performs the procedure by watching the progress of the wire and the plaque blade on a video screen. It's a little more labor intensive than what he's used to: a heart procedure might take between 60 and 90 minutes, while a leg might take three or four hours.

The PAD procedure is becoming a bigger part of his practice, Paustian said. While he typically operates on between 250 and 350 hearts per year, last year Paustian performed around 70 leg operations.

";Last month, I did more legs than hearts, which is hard to imagine," he said.

The risk factors for PAD are what would likely be suspected: smoking, high cholesterol, a fatty diet and high blood pressure can all contribute to the disease.

Paustian said he puts the plaque he collects from a patient into a glass vial, then sends it home with them.

";I tell them to put it on the breakfast table," he said. ";Every time you reach for the sausage or bacon, look at this vial, because this is where the sausage and bacon are going."

Reporter John Harrington: 447-4080 or john.harrington@helenair.com