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Saving limbs: Many amputations can be avoided

by Kamal Gupta, MD, Cardiologist and Vascular Specialist, and Karthik Vamanan, MD, Vascular Surgeon 

Could PAD be a factor?

Among the patients who should be evaluated for treatment of peripheral artery disease are
those with:

  • Uncontrolled diabetes
  • Heart disease
  • Cerebrovascular disease
  • Renal failure
  • Limb trauma
  • Ingrown toenails
  • History of tobacco use
  • Poor peripheral perfusion (as indicated by pulse exam)
  • Foot or leg pain – with or without activity
  • Poorly healing wounds in toes and/or feet
As many as 60-70% of amputations may be avoidable or reduced by treating previously unrecognized peripheral artery disease.

Physicians at The University of Kansas Hospital are at the forefront of treating peripheral arterial disease, or PAD, which causes critical limb ischemia and potential limb loss. Proficient in all techniques, they are able to tailor percutaneous, open or combinations of both to best suit the needs of the patient.

Many patients with limbs deemed unsalvageable have been treated, reducing pain, healing wounds and restoring function.

Risk factors for PAD include:

Conventional risk factors
  • Smoking
  • Diabetes mellitus
  • Hyperlipidemia
  • Hypertension
  • Renal failure

Predisposing risk factors

  • Advanced age
  • Overweight/obesity
  • Physical inactivity
  • Gender: males, postmenopausal females
  • Insulin resistance
  • Family history/genetics
  • Behavioral/socioeconomic factors

Any patient with non-healing wounds and foot or leg pain should be evaluated for PAD. Early and prompt diagnosis of PAD can prevent amputations. All patients with the risk factors listed here should also be evaluated for manifestations of PAD.

A pulse exam and ABIs are key parts of the physical examination. Identifying and treating risk factors early and modifying lifestyle are important in improving overall mortality and outcomes for these patients.

Multidisciplinary approach

The care of a patient with PAD and critical limb ischemia is difficult and often involves multiple specialties. At our institution, vascular surgeons, cardiologists, radiologists, wound care physicians, endocrinologists and orthopedic surgeons work together to treat these patients.

Patients receive comprehensive care for all co-morbidities. PAD usually accompanies cardiac and cerebrovascular disease, diabetes, hypertension and other manifestations of artherosclerosis.

Amputation

Amputation is a devastating event for patients and is not only lifestyle limiting but is often life limiting. Approximately 50% of patients undergoing an amputation will die within a year. There is a significant change in the quality of life, and less than 30% of patients over age 60 will ever walk again after an amputation.

At The University of Kansas Hospital, vascular physicians are dedicated to saving limbs that may otherwise have been amputated. We use the latest percutaneous and surgical techniques to revascularize patients and save limbs, lives and preserve the quality of life.

Stem cell study in critical limb ischemia

An FDA-approved study to use a unique stem cell product in the treatment of critical limb ischemia is scheduled to start at The University of Kansas Hospital in coming months. 

Patients scheduled for amputation will be enrolled in this study when they are not candidates for traditional methods of revascularization. Their stem cells will be harvested, infused and injected into the affected limb to allow for the development of new blood vessels and to heal refractory wounds.

The hope is that this will prevent amputations in these “no option” patients. This is a truly unique treatment not available at any other institution at this time.

There may be options available

Patients may find options at The University of Kansas Hospital that are not offered elsewhere. It may not be too late to save a limb by improving perfusion. The latest surgical and endovascular techniques or combinations thereof are tailored to fit the needs of each patient.

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