Amputation Prevention: Non surgical alternatives to amputation for peripheral artery disease (PAD)
What is peripheral artery disease (PAD)?
Narrowing of the arm and leg arteries is called peripheral arterial disease and is usually caused by atherosclerosis. Atherosclerosis is the build-up of fatty deposits on the vessel walls causing narrowing plaques that reduce blood supply and cause symptoms.
What are symptoms of severe peripheral artery disease (PAD)?
Symptoms of peripheral artery disease (PAD) include:
- tingling or leg pain during walking,
- leg cramps
- cold lower limbs
- shiny skin
- hair loss, slowly growing hair and toenails
Severe peripheral artery disease (PAD) symptoms include:
- rest pain at night or while lying down due to lack of blood flow to the arteries in your legs
- sores or ulcers that won't heal
These are warning signs and you should seek help for your peripheral artery disease (PAD).
What is critical limb ischemia and chronic critical limb ischemia?
Severe symptoms of peripheral artery disease (PAD) are caused by critical limb ischemia or more accurately chronic critical limb ischemia. Chronic critical limb ischemia occurs when decreased blood flow to the legs affects the muscles and nerves causing pain at rest or during walking. and non-healing sores or ulcers. Chronic total occlusions of a blood vessel or multiple occlusions of many blood vessels may be the cause. Your affected limb is at increased risk of developing serious complications from severe peripheral artery disease (PAD).
What are risk factors for severe peripheral artery disease (PAD)?
The risk factors for developing severe peripheral artery disease (PAD) include:
- Tobacco smoking
- High blood cholesterol and high blood pressure
Smoking causes peripheral artery disease (PAD) in above the knee and smokers will often present with intermittent claudication.
Diabetes seems to cause peripheral artery disease (PAD) below the knee resulting in significantly more occlusion in the large arteries of the calf (particularly in the peroneal and posterior tibial arteries). Diabetics also present often with gangrene and foot ulcers.
What is gangrene?
Gangrene is tissue death due to a lack of oxygen supply. Symptoms include black diseased tissue, rotting flesh and a foul odor coming from the affected area.
What is wet gangrene?
Wet gangrene is a severe infection of the tissue. It is caused from a lack of blood flow to the affected area. It most commonly affects the lower extremities, such as the feet and legs.
Symptoms of wet gangrene include:
- Black discoloration of the skin
- Skin that appears shiny or dark red in color
What is dry gangrene?
Dry gangrene is the death of tissue cells due to lack of oxygen supply with no infection present. The affected area often turns black, hard and dry. The tissue loses all its elasticity and becomes rock hard.
The toes are usually affected first, followed by the foot and lower leg. It is mainly seen in people who have peripheral arterial disease (PAD).
What are treatments for gangrene?
The treatment for wet gangrene is antibiotics and possible amputation.
The treatment for dry gangrene is to try and re-establish the limb with a good blood supply (revascularization) and then treat it with antibiotics.
Imaging & Interventional Specialists offer FDA-approved treatments (non-surgical alternatives) to prevent amputations.
Call us now or schedule an appointment to discuss your condition and your options.
What are amputations?
An amputation is the surgical removal of all or part of an extremity, such as a leg. It's done if you have gangrene and other treatments don't help reduce your pain and improve your quality of life. Amputations are most commonly performed on people with diabetes or peripheral arterial disease (PAD).
What are the different types of amputations?
There are many types of amputations including:
- above knee amputation : Loss just above the knee.
- below-knee amputation : Removal below the knee joint.
- shoulder disarticulation : Removal at shoulder joint just above armpit
- metatarsal amputation : Removal of any of the five long bones of the foot.
Why are amputations done?
Amputations are usually done to remove gangrenous tissue or when the disease has progressed.
How do amputations affect your life?
The loss of a leg or arm can impact a person's ability to walk or balance correctly. Daily life will be forever changed. Although medical advances have improved prosthetic options for amputees, an amputation is still a life-altering event that can significantly impact quality of life.
About 80% of patients experience phantom pain or other phantom limb sensations in their amputated limb. Amputation can affect body image even with an artificial limb. There are other ways amputations affect your life in terms of the complications they may bring you and affect they have on your life span.
What are complications of amputations?
Complications of amputations include:
- infection or continued infection or gangrene
- shorter stiffer limb with chronic pain
- lower wound healing
- decreased life expectancy
Since amputation happens to a limb whose circulation is already severe;y compromised risk of infection and slow healing is high. Again, the importance of early intervention with an aim of amputation prevention is key that may include lifestye changes, medications and "pinhole", non surgical procedures.
How many amputations are done?
Approximately 185,000 amputations are performed in the United States each year. It is estimated that 2 out of 100 people over 50 years of age will have an amputation in their lifetime.
What is your life expectancy after an amputation?
How does your life expectancy after an amputation compare with that of other Americans?
Untreatable foot problems in diabetics may require lower extremity amputation, which has a high level of patient mortality. This high mortality rate is worse than most malignancies!
Life expectancy is low (Some of the increased mortaility is due to the comorbities (other diseases) that amputees have so their risk of cardiovascular disease (eg heart attack) and cancer are higher.
Why amputation prevention?
So we can see by the effect of amputation on mortality, mobility, and quality of life that amputation prevention is a key goal. However, we have to accept that sometimes and amputation procedure is the only remaining option. Of course an amputation surgery should be prevented or put off for as long as possible.
Amputation prevention: How can it be done?
Amputation prevention can include:
- changing your lifestyle
- medicine that make blood less "thick" and expand vessels
- endovascular procedures: "pinhole" techniques to address problem areas
- advanced revascularization techniques
- bypass surgeries and endarterectomies
Amputation prevention: Lifestyle changes
Modifying lifestyle factors is important, you should:
- quit smoking
- control your diabetes
- decrease your weight
- eat better decreasing saturated fat
Amputation prevention: Medicines
Medicines to treat diabetes and atherosclerosis are important as well as medications that decrease blood "thickness" or increase the size of vessel allowing for improved blood flow.
The medicines include
- ACE inhibitors: decrease angiotensin II so decreasing high blood pressure
- ARB medications: decrease angiotensin II so decreasing high blood pressure
- Diuretics: decrease fluid retention and increase urine production
- Nitrates: increase blood vessel size and improve flow
- Heparin: prevent blood from clotting and improve circulation
- Clopidogrel: prevent blood from clotting by decreasing platelet aggregation (clotting)
- Statins: decrease cholesterol and other molecules that can cause atherosclerosis
- Aspirin: prevent blood from clotting by decreasing platelet aggregation (clotting)
- Cilostazol: increases blood flow by causing blood vessel to get bigger
- Pentoxifylline: decreases blood viscosity ("thickness")
Non surgical PAD treatment
- The aim of non surgical PAD treatment is to work with your care team to prevent amputation, usually leg amputation, given the negative associations including decreased life expectancy, mobility, physical activity, and wound healing after even minor injury. Usually there is "pinhole" access into an artery and a tiny catheter with miniaturized device is placed at the area of concern for treatment. During specialized minimally invasive, outpatient treatment the doctor may perform:
- diagnostic angiography: dye is injected and a "movie" made using X-rays to confirm a diagnosis and develop a treatment plan
- angioplasty: widening of any narrowed artery by inflating a timy balloon
- stent placement: keeping a narrowed portion open by putting a mesh cylinder at the area of opening
- atherectomy: using a tiny device inside the vessel to remove plaque
Atherectomy can involve:
- laser atherectomy: using energy from a laser beam to break up and remove plaque
- rotational atherectomy: using a tiny rotating cutter to remove plaque
Surgical PAD treatment
To prevent amputation a vascular surgeon might perform:
- vascular bypass
Vascular bypass involves taking a healthy vein or artery from another part of your body and using it to create a new path for blood to flow around the blocked or narrowed artery.
Endarterectomy is the removal of plaque from inside an artery. It can be done using various techniques, including open surgery. Here the surgeon makes a large cut in the thigh or groin and opens up the blood vessels to get to the blockage. Endarterectomy is the removal of plaque from inside an artery. It can be done using various techniques, including open surgery. Here the surgeon makes a large cut in the thigh or groin and opens up the blood vessels to get to the blockage.
What are the advantages of the minimally invasive, "pinhole" procedures performed by Imaging & Interventional Specialists?
Our seasoned board-certified specialists successfully perform “pinhole” procedures every day offering this region world-class, leading, state-of-the-art solutions to peripheral artery disease. Advantages include:
- Procedures are done in a comfortable outpatient setting with familiar friendly staff,
- Fast recovery,
- Less risk,
- Less pain
Why Imaging & Interventional Specialists?
Imaging & Interventional Specialists are experience procvider or world class minimally procedures aiming to prevent amputation. Every day out physicains perform "pinhole" procedures. They are leaders in interventional radiology and experts in the minimally invasive procedures that aim to prevent amputation.
Using state-of-the-art equipment, our seasoned board-certified specialists are dedicated to your best outcome.
At Imaging & Interventional Specialists our board certified physicians offer in-house testing to determine to diagnose PAD and to develop an individualized treatment program for your peripheral arterial disease and prevent amputation.