The Indian market has low awareness of Aortic and Peripheral Vascular (APV) therapy with only around 40-60 vascular surgeons performing endovascular surgeries as their primary procedure for patients says, Tony Semedo, Senior Vice President, Medtronic & President, Aortic & Peripheral Vascular, Medtronic in conversation with Romiya Das of Elets News Networks (ENN)
How do you see Aortic and Peripheral Vascular disease burden in India?
An aortic aneurysm is among the top 10 leading cause of death in the US and it generally affects the ageing population. India has no statistical evidence on the prevalence of this disease but going by US statistics, it affects about one per cent of the population above 60 years of one or more risk factors such as smoking, hypertension, age (men over 60; women over 65) suffering from coronary artery disease, already undergone Coronary artery Bypass Grafting (CABG), family history of an aneurysm. Since this disease is asymptomatic before rupture, a majority of patients are undiagnosed.
Peripheral Vascular Disease (PVD) in diabetes is complicated by peripheral neuropathy and susceptibility to infection, which leads to foot ulceration, gangrene and amputation of the affected extremity. The PVD affects 10 million people in India and more than 202 million people worldwide. In fact, India labeled as the diabetic capital of the world and there is a strong correlation between PAD and diabetes. Patients suffering from diabetes tend to develop PAD as they grow older and the condition aggravates if they are already suffering from CHD or are smokers. Other statistics include – it is estimated that 20-30 per cent of diabetic patients over 65 years of age have the peripheral arterial disease; approximately 30 per cent of these diabetic patients with PVD require surgical or percutaneous revascularisation. 10 per cent require an amputation of the affected limb within 5-10 years of diagnosis; one-third of all diabetic patients have significant peripheral neuropathy and/or PVD; 40 per cent patients of coronary artery disease have associated peripheral vascular disease. In spite of these statistics, these therapies are significantly under-penetrated as patients associate limb ischemia with old age and do not seek treatment.
Globally venous insufficiency affects more than 192 million people and is common in women who have had two or more pregnancies. CVI disease has risk factors that include age, pregnancy, obesity, extended periods of standing and sitting. This is a new and emerging therapy in India. Some of the key symptoms include varicose veins, leg pain, aching, or cramping, leg or ankle swelling, leg heaviness and fatigue, skin changes or rashes, ulcers, open wounds, or sores.
What challenges and opportunities do you see in Indian APV therapy market?
Some of the key challenges in the AVP therapy market include low awareness for aortic; peripheral and endovenous therapies as the diseases generally affect older adults, access to health insurance coverage; lack of proper screening protocol for patients; lack of adequate infrastructure. A very few hospitals in India have a dedicated catheterisation lab or Operating Room (OR) for aortic endovascular repairs to be performed; scarcity of skilled physicians and doctors. Since many vascular surgeons do not have the opportunity to perform endovascular procedures, the majority of procedures are performed with open surgical. Therefore, there are only around 40-60 vascular surgeons in India who perform endovascular surgeries as their primary procedure for patients.
What is new in India regarding the APV business?
Two years ago, Medtronic introduced drug-coated balloons to treat peripheral vascular disease located in the lower extremities, specifically claudication within the Superficial Femoral Artery (SFA) in India. We continue to work on raising awareness of claudication and the ability for drug-coated balloons to alleviate the symptoms with this disease and minimise the number of re-interventions in order to treat it. Given the high prevalence of diabetes in India there also is a very high prevalence of PAD found in the vessels below the knee (BTK). We are currently working on developing a DCB specifically designed for the vessels BTK. After regulatory approval, we would commercialise the DCB for the BTK in India and other commercialised markets where we have a presence. These efforts involve significant investments in clinical studies to demonstrate efficacy and product safety. In addition, we will also continue our investment in registry studies to evaluate patients in the real-world patient population. Medtronic will be investing in training and education programs to increase public awareness of all three therapy franchises present in India, including peripheral vascular disease, aortic and endovenous disease. Medtronic also plans to train about 200 physicians over the next several years.
Medtronic will be investing in training and education programs to increase public awareness of all three therapy franchises present in India, including peripheral vascular disease, aortic and endovenous disease. Medtronic also plans to train about 200 physicians over the next several years
Elaborate on Medtronic’s APV therapies portfolio?
Aortic vascular therapies – Leveraging decades of clinical experiences and data, Medtronic’s core technologies for treating abdominal aortic aneurysm (AAA) and descending thoracic disease, the product lines Endurant and Valiant have been proven effective in more than 280,000 patients globally. Our mission is to improve patient outcome and our commitment is to build and invest in complementary innovative technology that will allow physicians to treat more complex aortic disease.Peripheral vascular therapies – Medtronic offers one of the most robust product portfolios for the treatment of peripheral vascular disease, PVD. This includes drug-coated balloons (DCB), atherectomy, stents, PTA balloons, and a wide variety of accessories to aid the delivery of therapy.
Peripheral vascular therapies – Medtronic offers one of the most robust product portfolios for the treatment of peripheral vascular disease, PVD. This includes drug-coated balloons (DCB), atherectomy, stents, PTA balloons, and a wide variety of accessories to aid the delivery of therapy.
How do you see the role of information technology in the healthcare sector?
Over the past decades, advancement in the medical sector and procedural techniques has redefined the face of healthcare. Medical device technologies have enhanced the quality and effectiveness of healthcare for millions of patients worldwide. Pacemakers, drug coated balloons, implantable cardioverter defibrillators, coronary drug eluting stents, and non-invasive diagnosis with ultrasound technology are some of the examples of the products that are available today because of the continuous medical technology innovation. Medical technology extends and improves life, alleviates pain and restores health.