Deciding between amputation and revascularization

Revascularization or Amputation?

Technology has opened the door for innovation in medicine that has led to great advances in the treatment of many chronic diseases. Over the last 20 years, patients with Peripheral Artery Disease have benefited from life-saving revascularization treatments that are minimally invasive and focused on limb salvage. These changes although remarkable for those with success stories, don’t come without scrutiny and can result in tension within the vascular community.

The History of PAD Treatment

Historically, treatment for peripheral artery disease is based on risk-factor management or surgical interventions that were only done in a hospital setting.

Risk Factor Management

Roughly 30% of Modern Vascular patients receive a recommendation to move forward with a procedure at their initial consultation. Many more are recommended to control their risk factors through:

Interventions & Amputations

If risk factor management approaches are not successful, other treatment options include revascularization therapies to treat blockages. Revascularization techniques can be minimally-invasive using stents and balloons or can include open surgery such as bypass surgery.

Treatments for Severe PAD Include:

  • Balloon Angioplasty/Stenting
  • Bypass Grafting
  • Cryoplasty
  • Percutaneous or Laser Atherectomy

Patients with critical limb ischemia have an advanced form of peripheral arterial disease where patients are getting no blood flow in their foot and are in danger of losing a leg to amputation.

Amputation is a procedure used when tissue destruction, infection, or disease affects a body part so severely that it is impossible to repair or puts the person’s life in danger. For instance, in PAD patients, a foot or leg may be removed by surgical amputation if blood flow cannot be returned to the foot or leg.

Unfortunately, amputation can impact a patient’s life expectancy. According to a study in Vascular Health and Risk Management, the rate of death after major lower extremity amputation in the US is approximately 48% at year 1, and 71% at year 3.4  

This is why it is so important to catch PAD early so that a doctor can intervene before the disease cuts off blood flow to a body part for an extended period of time, leaving the patient with limited options.

About 54% of all surgical amputations result from complications of vascular diseases and other conditions that affect blood flow, such as diabetes and PAD.2

Chronic vascular problems can lead to tissue death in the toes, feet, and legs. Of patients undergoing amputation for complications of these diseases, nearly half will die within five years of the amputation procedure.

Innovation & Tension in the Vascular Community

Over the last decade, there have been great advancements in the treatment or therapy used for Peripheral Artery Disease. PAD affects 8 to 10 million Americans, primarily those with diabetes, over the age of 65, and ethnic groups including Black, Latinx, and Indigenous communities. With technology, we have been able to detect PAD much earlier and treat it without the need for amputation or other invasive procedures.

The innovations have not come without a cost, as there is a bit of tension within the vascular community on the legitimacy and necessity of certain approaches.

With regard to the evolution of medical innovation, not everyone has been this forward-thinking. While some in the vascular community hesitate to deviate from the traditional methods, tension is increased further as many vascular surgeons who are not embracing endovascular treatment are losing patients to those who are. These revascularization procedures can be done more safely and earlier in the disease progression, in outpatient facilities like Modern Vascular with multiple clinics throughout the country.

Patient advocacy has played a huge part in emphasizing the importance of treatment options for patients because the patient’s best interest should ultimately be the focus of care. Patient advocate and Founder of The Way to My Heart, Kym McNicholas shares, “When it comes to treating patients with peripheral artery disease, every single vascular physician needs to respect the fact that different doctors have different tools, techniques, and approaches… Patients should be made aware of, whether one physician or another offers them so that they can make a well-informed decision on what it will take to give them a better quality of life.”

Sources:

  1. Logar, C. M., Pappas, L. M., Ramkumar, N., & Beddhu, S. (2005, March 21). Surgical revascularization versus amputation for peripheral vascular disease in dialysis patients: A cohort study. BMC nephrology. Retrieved December 2, 2021, from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1079864/.
  2. Amputation | Society for Vascular Surgery. Retrieved December 8, 2021, from https://vascular.org/patients/vascular-treatments/amputation.
  3. Torbjörnsson E;Ottosson C;Blomgren L;Boström L;Fagerdahl AM; (n.d.). The patient’s experience of amputation due to peripheral arterial disease. Journal of vascular nursing : official publication of the Society for Peripheral Vascular Nursing. Retrieved December 21, 2021, from https://pubmed.ncbi.nlm.nih.gov/28527728/
  4. Swaminathan, A., Vemulapalli, S., Patel, M. R., & Jones, W. S. (2014, July 16). Lower extremity amputation in peripheral artery disease: Improving patient outcomes. Vascular health and risk management. Retrieved December 21, 2021, from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4107174/
  5. Innovations in pad therapy: Make sure you’re up-to-date on … (n.d.). Retrieved December 21, 2021, from https://journals.lww.com/nursing/Fulltext/2008/03001/Innovations_in_PAD_therapy__Make_sure_you_re.3.aspx

Peripheral Artery Disease can be effectively treated when diagnosed early and properly.

You can schedule a comprehensive evaluation for peripheral artery disease at a Modern Vascular clinic if you believe that you are at risk or to put your mind at ease.

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