Monday, August 8, 2016

Endovascular Amputation Prevention

By Christopher A. King, MD, FACC
Cardiologist with Alabama Cardiovascular Group an affiliate of Grandview Health

From a patient’s perspective, few events are more devastating than the loss of a limb. Moreover, critical limb ischemia is associated with increased mortality, decreased functional capacity and diminished quality of life. Approximately 25 percent of newly diagnosed patients will require an amputation within one year and the average survival after diagnosis is approximately two and a half years.

The technology for endovascular limb salvage has advanced at a rapid pace over the past few years. Operator experience has followed. The impact that timely treatment of critical limb ischemia can have should not be underestimated. A multidisciplinary approach to critical limb ischemia can result in a marked decrease in amputation in this patient population.

The standard endovascular approach for treatment of chronic limb ischemia utilizes catheters, guidewires and balloons to increase blood flow to the impacted limb. In many cases, critical limb ischemia is caused by the below the knee vessels which are roughly the same size as the coronary vessels. Hence, treatment of these vessels borrows strongly from paradigms for treating coronary vessels. This, however, is not always fully effective as the vessels may react differently than the coronary vessels.

Refinement of technology for atherectomy, angioplasty (in addition to the development of drug coated balloons) and stenting have allowed us to approach the disease in ways which only a few years ago would have not been possible. Specific angiosomes may be targeted to allow optimal wound healing when a limb is at risk. Pedal access has allowed us to cross lesions that we were once unable to cross. Ultrasound can be utilized in the catheterization lab to minimize radiation and fluoroscopy as well as increase the success of the procedures. Early recognition of peripheral artery disease (PAD) prior to the development of critical limb ischemia may further reduce the risk of amputation as well as identify patients at risk for coronary artery disease and stroke.

Alabama Cardiovascular Group and Grandview Medical Center have developed a comprehensive center for advanced disease management which includes a limb salvage discipline to treat those who are most at risk. Our physicians are experts at diagnosing and treating peripheral arterial disease in patients prior to the development of critical limb ischemia and in utilizing cutting edge techniques to salvage a limb when there is risk of limb loss. The Center for Advanced Disease Management at Grandview will also coordinate with endovascular and endovenous specialists, wound care experts, surgeons, endocrinologists and primary care physicians to help insure that a patient’s needs are fully addressed.

For more information please call Alabama Cardiovascular Group at 205-971-7500.

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