Amputation prevention, is a comprehensive approach that can decrease the lower extremity amputations particularly in patients with PAD and diabetes.
Amputation prevention has particular focus on saving limbs especially after ulcers, infection and gangrene have set in.
Once a wound on the foot has developed, the focus is to improve circulation with advances in technology including patients that were previously not considered candidates for any type of procedures or revascularizations.
Endovascular surgery is a form of minimally invasive surgery to access and treat many arteries in the body by introducing a catheter typically into the femoral artery (in the groin) and subsequently diagnosing and treating the diseased arteries with X-ray guidance. Typically arteries are opened up with a balloon (angioplasty) and some are further treated with a stent.
Vascular treatments with endovascular surgery (minimally invasive) and vascular bypass surgery improve the circulation and can prevent the need for amputation of a limb
Among people with diabetes and peripheral artery disease, early intervention and increased patient education have been associated with reducing the incidence of amputation
Diagnosing and treating potential risks for amputation in patients with diabetes and peripheral arterial disease (PAD) is the immediate focus of amputation prevention.
A recent study showed that the earlier vascular intervention lead to better outcomes and lower amputation rates.
Detection of PAD
Detection of PAD can be done with non-invasive tests that can check the pressures in the arteries and ultrasound can directly visualize the artery and blood flow.
If one is suspected of having poor circulation, one typically will proceed with an angiogram.
An angiogram or angiography is an X-ray test that uses a special dye or CO2and a camera (fluoroscopy) to take pictures of the blood flow in an artery. This then serves as the roadmap or blueprint on how to improve the circulation.
Unfortunately, angiography has been under utilized in CLI patients and was as low as 27% in 1 large study.
In a study in 2011 of more than 1 million Medicare in patients with CLI found that if the patient had an angiogram the chance of amputation was reduced 90%.
Even patients in their 80’s and older benefit from endovascular interventions with lower risks than standard open vascular surgery.
Selective angiography, involves placing a catheter in the artery very close to the ischemic segment of the foot (i.e. area of low blood flow) such as in the popliteal artery behind the knee. This allows identification of therapeutic targets in the small arteries in the lower leg, ankle, foot and even extending beyond this point.
Treatment of PAD
Improving impaired circulation is one of the key ingredient to saving limbs.
If there is significant impairment of blood flow, either an angioplasty (opening up the artery with a balloon) or open bypass surgery may be required. Other techniques that are also utilized include the use of atherectomy (Roto-Rooter), laser, and stents
When a bypass is necessary it often must extend all the way down to the foot and not just the knee.
Other Components of Amputation Prevention
- Typically after the patient has been revascularized, aggressive treatment ensues.
- Debridement of the wounds (removal of unhealthy and dead tissue)
- Systemic hyperbaric oxygen therapy
- Bioengineered skin substitutes
- Hyperbaric medicine
- Debridement of the wounds (removal of unhealthy and dead tissue)
- Podiatric care
If you are a patient with diabetes or peripheral arterial disease, you may be at risk for complications that put your limbs at risk. Take the first step to preserving your limb function and your quality of life. Call the Amputation Prevention Center at 941.312.6196.