What is Endovascular Limb Salvage?
The term endovascular refers to “inside a blood vessel.” Endovascular limb salvage is a minimally invasive surgery performed through the blood vessels to save a limb (normally one of the lower extremities) from amputation resulting from conditions such as acute limb ischemia (ALI) and chronic critical limb ischemia (CLI).
Indications for Endovascular Limb Salvage
Your surgeon may recommend endovascular limb salvage if you have vascular conditions such as peripheral arterial disease, diabetic arterial disease, venous pressure, venous hypertension, arterial insufficiency, and critical limb ischemia. These conditions can cause blockages in the arteries, restricting blood supply to the limbs, and placing them at high risk for nonhealing wounds, infection, and, finally, amputation. Endovascular limb salvage is a technique employed by vascular surgeons to re-supply or revascularize blood supply to the affected limb, if required all the way down to the toes, to enable wound healing and the patient to salvage (save) the limb.
Preparation for Endovascular Limb Salvage
Preoperative preparation for endovascular limb salvage surgery may involve the following steps:
- A review of your medical history and a physical examination to check for any medical issues that need to be addressed prior to surgery.
- Routine diagnostic tests such as blood work and duplex/doppler ultrasound scans to assess blood flow to the limb and the state of the blockage.
- You will be asked if you have allergies to medications, anesthesia, or latex.
- You should inform your doctor of any medications or supplements you are taking or any conditions you have such as heart or lung disease.
- You may be asked to stop taking blood-thinners, anti-inflammatories, or other supplements for a week or two.
- You should refrain from alcohol and tobacco at least a few days prior to surgery and several weeks after.
- You should not consume any solids or liquids at least 8 hours prior to surgery.
- Continue taking your blood pressure medication on the day of surgery.
- You may be asked to stop certain blood thinners prior to surgery including coumadin, Eliquis, Xarelto, Aspirin, Plavix.
- Arrange for someone to drive you home as you will not be alert enough to drive yourself after surgery.
- Informed consent will be obtained from you after the surgery has been explained in detail.
Procedure for Endovascular Limb Salvage
Endovascular limb salvage typically involves a minimally invasive procedure called angioplasty - a procedure to push plaque (fatty deposit) blockages against the walls of an artery. In general, the procedure involves the following steps:
- You will lie on your back on the procedure table and local anesthesia is administered.
- A small surgical cut is made on the groin or wrist, depending upon the region of the narrowed vessels.
- A dye is injected into the body to view the blood flow through the arteries, and X-rays are taken.
- Using these live X-ray images, your surgeon inserts a thin guide wire through a blood vessel in the groin area and extends it up to the blocked artery.
- A balloon catheter (thin tube) is then threaded through the guidewire to the narrowed artery.
- The balloon catheter has a deflated balloon at its tip, which is inflated at the site of the blockage.
- The balloon widens the artery by compressing the plaque against the wall of the artery.
- Your surgeon may also insert a wire mesh tube called a stent along with the balloon catheter to help keep the artery open and prevent it from narrowing again.
- The balloon and the catheters are removed, while the stent is left in place to keep the artery wide open and allow free flow of blood to the limbs.
Post-Procedure Care and Recovery
In general, post-procedure care and recovery after endovascular limb salvage will involve the following steps:
- You will be transferred to the recovery room where your nurse will monitor your vital signs as you recover. You will be able to start walking in 2 hours after the procedure.
- You will be able to go home the same day.
- You may experience pain, swelling, or discomfort for which your physician will prescribe appropriate medications.
- You are encouraged to walk as frequently as possible to prevent the risk of blood clots. You may also be given blood-thinning medications to prevent blood clot formation.
- Instructions on incision site care and bathing will be provided to keep the wound clean and dry.
- Refrain from strenuous activities, lifting heavy weights, and driving for a defined period. A gradual increase in activities is recommended.
- You should be able to return to work and resume your normal daily activities in a couple of DAYS with certain activity restrictions.
- You are advised to take all your prescribed medications and make a few lifestyle changes such as quitting smoking, exercising regularly, maintaining a healthy weight, and eating a healthy diet.
- A periodic follow-up appointment will be scheduled to monitor your progress.
- Most patients start a 90 day course of Plavix post operatively.
Risks and Complications
Endovascular limb salvage is a relatively safe procedure; however, as with any procedure, some risks and complications may occur, such as the following:
- Wound infection
- Anesthetic/allergic reactions
- Pain/swelling at the catheter insertion site
- Graft migration
- Injury to adjacent nerve or blood vessels
- Kidney damage due to the dye used
- Blood clots