When you have Type 2 diabetes, you’re at a higher risk for peripheral arterial disease (PAD) as well as critical limb ischemia (CLI). With CLI, there’s also a risk of tissue loss from ulcers and gangrene. And, for that reason, you’re more likely to need chronic limb-threatening ischemia treatment (CLTI).
Recently, a study came out explaining how endovascular treatments can help with CLTI outcomes. Of course, our Houston and Dallas area interventional radiologists are excited about these findings. So, today, we’ll review how endovascular therapy can improve ischemia treatment outcomes. But first, let’s take a closer look at the complex conditions we’re exploring in this post: PAD, CLI and CLTI.
Peripheral Artery Disease (PAD) describes a build-up of plaque in your arteries. With this condition, you’ll experience slower blood flow from the heart to the rest of your body. But what’s that plaque composed of? Well, it forms from cholesterol, calcium, fibrin, and fatty substances. Over time, that mix narrows or ‘hardens’ your arteries. (We call this Atherosclerosis.) And, once atherosclerosis sets in, reduced blood flow to your vital organs and limbs will make it harder for them to keep up with your body’s demands. Soon, you’ll notice painful PAD symptoms such as leg cramps with movement. You may also develop changes in skin color, patches of hair loss on your legs, ulcers and other warning signs and symptoms.
This is a severe form of PAD. When you have CLI, you often experience chronic pain, even without movement. Your risk for ulcers and gangrene are also much higher. And that’s because of the long-term lack of sufficient blood flow to your lower limbs.
With CLI, you may also experience unpleasant symptoms such as foot pain and/or numbness, and a reduced or missing pulse in your feet. Additionally, leg and foot wounds will take longer to heal, which is why you’re at greater risk for ulcers and tissue death.
This is a clinical diagnosis we’d make if you have PAD as well as resting foot pain and a lower leg ulcer or a gangrenous patch for 2 weeks or longer. We consider this diagnosis to be extremely dangerous; with CLTI, you’re at a very high risk for limb loss.
Furthermore, research reveals that chronic limb-threatening ischemia increases social isolation, especially for younger patients, which was surprising since older adults are usually more susceptible to loneliness. Clearly, CLTI takes a physical and emotional toll on your body. So you need to seek ischemia treatment. And, according to new study findings, seeking endovascular care to open up your arteries could be a great option.
Clearly, seeking ischemia treatment can prevent limb loss. And that’s especially true for people with diabetes, who have additional circulation challenges, even without PAD. Until recently, ischemia treatment options included wound treatment, controlling the infections, and arterial revascularization. In many cases, amputation was unavoidable.
Now, there are two ways to pull off arterial revascularization. These include bypass surgery or endovascular interventions. As interventional radiologists, we always prefer the endovascular approach. We believe that it minimizes the risks of undergoing open surgery. Plus, it does so while yielding similar or greater results.
But you don’t have to take our word for it! In fact, in a recent review of two patients with CLTI, researchers followed two diabetic patients with unhealed lesions. Both patients received quality wound care, help for their glucose levels, and endovascular therapy to restore blood flow. Here’s what the study revealed about this approach to ischemia treatment.
The two patients involved in this study received endovascular therapy to restore arterial blood flow. For the first patient, that meant an angioplasty. With this approach, therapists use a balloon to widen a diseased artery. And that way, more blood flows through.
Now, the second patient’s therapy involved stent placement in the diseased artery. That means doctors placed a tiny, expandable coil in the troubled artery. This coil can push aside built up plaque and help boost blood flow to the lower limbs.
While both endovascular patients received different forms of therapy, they enjoyed similar results. Their wounds healed, and their painful symptoms resolved. As such, researchers concluded that seeking ischemia treatment with an endovascular procedure “may result in a better outcome of wound healing.”
For some patients with CLTI, revascularization is no longer an option. And these are the very patients at most risk for an above-ankle amputation. Luckily, emerging results from the Promise II clinical trial reveal a new procedure that may offer hope for limb protection.
In this ongoing study, patients received transcatheter arterialization for their deep veins (TADV). This was accomplished with a minimally invasive procedure using the LimFlow System. Basically, this procedure gets blood flow around the permanently blocked leg arteries by 'turning off' valves in the lower leg vein. In this way, the veins are now able to carry blood down to the foot, giving it the oxygen necessary to avoid amputation.
Though the research is still in a trial phase, early results are promising. Six months after receiving TADV, 76% of the patients in the study were able to keep their limbs. As such, we will be carefully watching ongoing research into this procedure. But, in the meantime, we encourage earlier interventions, so that arterial revascularization is still a viable treatment option.
Are you living with PAD and worried about CLI and limb loss? Our Houston and Dallas area vein specialists are here to help. In our Houston, Katy, Sugar Land, Clear Lake and The Woodlands locations, we offer arterial angioplasty, stenting and atherectomy therapies. So, if you’ve been told that ischemia treatment is the best way to save your limbs? Don’t rush to the surgical table. Instead, schedule a consultation with our vein specialists in Houston and Dallas. We’ll help you explore less invasive ways to find PAD treatment and prevent amputations!
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