Leg Stenting Prevents Amputation

Andrew Feiring, MD, FACC, FAHA, FSCAI, Interventional Cardiologist, Columbia St. Mary’s

Posted: April 1, 2008

Peripheral Arterial Disease (PAD) is a silent disease where the arteries of the leg become narrowed and clogged with fatty deposits or plaque. Too often this condition goes undiagnosed and is frequently untreated. Left untreated, PAD may result in discomfort when walking and progress to foot gangrene or wounds that fail to heal. In fact, PAD is the leading cause of amputation.

However, there is new hope for patients with severe PAD. At Columbia St. Mary’s, a team of researchers developed a new method for preventing amputation using drug-eluting stents.

Recently, a patient was referred to me for non-healing sores of his right foot and was recommended amputation below the knee. He suffered from resting foot pain that was especially severe while sleeping. After an angiographic evaluation (small tubes that are placed in the groin and dye is injected providing a picture of the arteries of the legs), we found he had complete blockage of the main artery between his thigh and knee as well as all three arteries below the knee. We opened the blocked arteries using various small wires and a number of drug-coated stents. These stents serve the dual purpose of propping open the artery and preventing scar formation. Immediately after the artery was opened, the patient noted that his foot and leg were warm and he now had sensation when previously all he felt was a “block of ice.”

The next day the patient was discharged with only a small Band-Aid on the back of his knee. Within two weeks his foot ulcers had healed, and for the first time in two years he was able to go shopping and walk his dog! Using drug-eluting stents has minimal risks, little discomfort and nearly all patients are discharged within 24 hours. We are able to reduce the risk of amputation from 40 percent (the standard surgical approach) to 8 percent in patients successfully treated. Moreover, the risk of dying has been reduced by 20 percent over three years. The most gratifying aspect of this work has been the knowledge that by preventing amputation, relieving pain and improving their ability to walk, patients have a better quality of life and are able to remain independent.

There are more than 12 million Americans at risk for vascular disease. Yet few physicians are aware of the new options available for treating these patients. As a pioneer of new methods for treating patients with vascular disease, I feel that it is extremely important that anyone who suffers from vascular disease be evaluated by someone who is skilled in endovascular therapy (opening up arteries from the inside of the blood vessel with wires, balloons and stents) since the risk of this technique is far less risky than the traditional surgical approach. Our research has shown that treating patients at risk of amputation with drug-coated stents is currently the most effective means of preventing amputation. The more we learn about the disease and how it advances, the better able we are to tailor a treatment plan to each patient with the goal of ending leg pain and saving the leg.

Andrew Feiring, MD, FACC, FAHA, FSCAI
Interventional Cardiologist
Columbia St. Mary's Vascular Institute
414-961-VASC (8272)

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