A proven treatment for coronary artery disease now restores health to blood-starved limbs in patients with peripheral artery disease.
Cleveland Clinic is a non-profit academic medical center. Advertising on our site helps support our mission. We do not endorse non-Cleveland Clinic products or services. Policy
Endovascular reconstruction is a minimally invasive procedure. The procedure is similar to the balloon angioplasty and stenting used in coronary arteries. It provides a limb-saving option for some patients who have been told that they face amputation.
The procedure doesn’t cure peripheral artery disease (PAD), but it can save your limb and help preserve your mobility.
PAD and restricted blood flow
When you develop peripheral artery disease, deposits build up in your artery walls, just as they do in your coronary arteries. In fact, if you have coronary artery disease, you are at greater risk for developing PAD.
When you have PAD, narrowed, clogged arteries restrict blood flow to your body and limbs.
Claudication or muscle pain and cramping during walking or exercise occurs as PAD progresses. Sometimes a combination of severe PAD, diabetes and injury may result in wounds or ulcers which may lead to lower leg amputation.
When blood flow is severely restricted, ulcerations and slowed wound healing compound the problem. The worst-case scenario: tissue death, gangrene and amputation.
A special endovascular procedure helps head off amputation
Minimally invasive percutaneous procedures can help prevent amputation and restore blood flow to damaged tissue. Usually you can resume your normal activities with full mobility a few days after successful treatment.
During the procedure, interventionalists guide a catheter into place through a small incision. Guided by ultrasound, they position and inflate a balloon to open up the artery and sometimes even place a stent in order to keep the artery open.
After treatment, blood flows once again to the limb and reverses injury to tissues.
Evaluation is a must before amputation
Mehdi H. Shishehbor, DO, MPH, PhD, Director of Endovascular Services in Cleveland Clinic’s Department of Cardiovascular Medicine, specializes in revascularization therapy. He stresses the importance of using this technique to save the limbs of patients who face amputation.
“Currently, 40 percent to 70 percent of patients who undergo amputation in the United States do not get a full vascular evaluation in the year prior to amputation. That is amazing data,” Dr. Shishehbor says. “Yet, for us the most important measure of success of the intervention is not a salvaged limb, but rather how quickly after the procedure the patient can return to full activity, begin working, and enjoy a quality life without amputation.”
Demonstrating the newest techniques
Recently, Dr. Shishehbor demonstrated the advances in endovascular reconstruction as reported in Cardiology Today. He focused on the artery to the injury site rather than other arteries that may not directly supply blood to the ulcer or the wound.
By taking a personalized approach to each patient and ulcer, he gets positive results in complicated cases, such as in many patients that have been told amputation is the last resort. His work has been recognized locally, nationally and internationally.
PAD and your health
If you have been diagnosed with PAD, or if you have been diagnosed with coronary artery disease or diabetes, pay careful attention to the health of your legs and feet. These are the areas that suffer first from insufficient blood flow.
Follow these tips to help avoid serious problems:
- Identify — Check your feet and ask your physician to look at possible early signs of circulation problems such as reduced pulse.
- Investigate the cause.
- Get treatment — Don’t wait. Seek help immediately.
It’s important to understand why sores or ulcers occur. Tell your doctor if they develop or are not healing so that he or she can look for the cause. In general, bad circulation sets the stage for problems. This makes typically temporary injuries or other factors much more serious. Potential problems can include:
- Bug bites
- Stopping prescribed medications
- New, badly fitting shoes
- Burns to the skin, such as those from walking on hot pavement. (Patients with diabetes can also suffer nerve damage that makes it harder to tell when water or surfaces are dangerously hot).
What you can do
If you have conditions that put you at increased risk for limb loss, take action:
If you notice a sore on your foot or leg or if you notice any change in your health, call your physician or seek emergency medical care.
With prompt medical care and surgical treatment you should be able to keep your limbs and your independence intact.