Amputation prevention
The amputation prevention (also known as limb salvage) program at the Division of Vascular and Endovascular Surgery at the Downstate Health Sciences University is committed to improving the care of patients with chronic limb threatening ischemia. This multidisciplinary team consists of specialists in vascular surgery, plastic surgery, orthopedic surgery, infectious diseases, endocrinology, and wound care that work closely together to deliver expert care. We use state-of-the art imaging and techniques to diagnose, treat, and follow-up our patients after intervention to preserve limb function and mobility and minimize major amputations.
Amputation is the end result of chronic limb threatening ischemia, a condition of extensive arterial stenosis or occlusion of large and small arteries of the leg due to atherosclerosis. Atherosclerosis is a chronic disease that sometimes may progress for years without causing any symptoms.
Conditions of we treat
- Claudication (pain after walking a short distance)
- Rest pain
- Non-healing ulcers
- Dry or wet (infected) gangrene
- Aneurysms in the leg
To book an appointment
Call: 718-270-1981
Email: vascular@downstate.edu
Management options
We offer several treatment options to improve blood flow, promote healing, and reduce the risk of amputation. A specific therapy plan is tailored for each patient, depending on patient preferences, risk profile, and potential to ambulate after a surgical intervention. Medical therapy and appropriate risk factor modification is the cornerstone for management of every patient with atherosclerosis and related compromised arterial flow in the extremity.
A. Medical Therapy
- Managing the overall health is the most important step in prevention of amputations and limb loss. There are lifestyle modifications that can help improve one's overall health. These include regular exercise, smoking cessation, improved diet, and taking the appropriate medications for any underlying medical conditions. We also encourage patients to routinely monitor their feet and legs for injuries.
- Patients with very advanced atherosclerotic occlusive disease that puts a limb at risk will need, in addition to medical therapy, a revascularization procedure, either open or endovascular.
B. Endovascular (Minimally invasive) revascularization
- Balloon angioplasty and stenting – a minimally invasive technique that uses balloons and stents to open a narrow or blocked artery to improve blood flow
- Atherectomy. This is a procedure that scrapes away the buildup of atherosclerotic disease at a narrow or blocked artery.
- Retrograde pedal access. Arteries at the ankle and foot are accessed to help open a narrow or blocked artery with balloon angioplasty or stenting.
C. Open Surgical revascularization
- Endarterectomy. This involves removal of the atherosclerotic plaque from the occluded vessel. It is usually appropriate when the plaque is well localized, and it is typically used for occlusions or stenoses of the common femoral artery.
- Surgical bypass. This is the procedure of choice for extensive occlusions that are not amenable to angioplasty and stenting. The blood is re-routed around the occlusion using a conduit - either the patient's own vein, a prosthetic bypass, or a cadaveric blood vessel.
D. Debridement
- Removal of damaged or infected tissue to improve the healing ability of remaining tissue. It typically involves the foot, or any other part of the leg that has ischemic, gangrenous tissue
E. Amputation
- Some patients are not candidates for revascularization due to the very extensive atherosclerotic occlusions of their vasculature. In these cases an amputation is required. Sometimes we may perform revascularization procedures to ensure the patients lose as little of their foot or leg as possible and to ensure proper healing.
- Although an amputation is never welcome, at times is the only option available to reduce the chance of extensive limb infection, which may be fatal. Physical therapy, use of appropriately fitted shoes and if necessary use of prosthesis, can optimize mobility even after extensive amputations.