Some patients who suffer from severe coronary artery disease have already undergone bypass surgery, but are not possible candidates for angioplasty or reoperation, and cannot be helped further by medication, lifestyle, and exercise modifications. To treat these patients, physicians turn to symptomatic relief therapies such as EECP (external enhanced counter pulsation). EECP is a noninvasive technique intended to help improve circulation.

In EECP, the physician applies blood-pressure cuffs to the patient's legs. The balloon devices contained in these cuffs are timed with an electrocardiogram to compress the legs during diastole, squeezing blood backward through the arteries and up to the aorta. During diastole, the heart relaxes and the coronary arteries are refilled, distributing blood to the heart muscle. In systole, the heart contracts to pump blood to the rest of the body. The heart feeds itself out of synch with the rest of the body.

	The use of VEGF led to the growth of new arteries in this patient's leg.

EECP takes advantage of this cycle by compressing the arteries to augment the return of blood into the aorta and the coronary arteries. EECP has provided some symptomatic improvement in patients who have no other therapeutic options. Treatments usually last one hour and are conducted for 30 to 35 consecutive days. The treatments can be repeated in the future, should symptoms recur. EECP remains controversial as to its long-term value and should be considered as an adjunctive treatment.

The intent of VEGF (vascular endothelial growth factors) is to spur the growth of new arteries in the heart, particularly the smaller arteries in the heart called collaterals. Collateral arteries can create a type of natural bypass for patients, branching off adjacent arteries to reach and fill blocked regions. While the growth of collateral arteries can occur naturally, sometimes in response to exercise, no consistent medical treatment has previously been guaranteed to develop them. VEGF hopefully will deliver on that promise. Still an experimental therapy, VEGF is currently being applied to a few patients. Its long-term benefits await further study.