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Cardiologist teams up with Podiatrist to
save Diabetic patient's leg
Newswise — Bernice Smith of Maywood already
had lost her right leg to diabetes, and now
her left leg was in danger of amputation.
But there was a chance her leg could be
saved if adequate blood flow could be
restored. Smith's podiatrist, Dr. Ronald
Sage of Loyola University Hospital, referred
her to Loyola interventional cardiologist
Dr. Robert Dieter, who lives in Glen Ellyn.
Using a catheter, Dieter performed a
difficult balloon angioplasty in a major
artery in Smith's left thigh, similar to the
technique cardiologists use to open clogged
heart arteries.
Dieter placed a stent to keep the artery
open. The procedure restored blood flow to
Smith's leg, which had started to turn
gangrenous because it wasn't getting enough
blood.
Although Sage had to amputate Smith's toes,
the rest of her leg was spared. "I can't
stop thanking both of them for saving my
leg," she said.
Dieter said he receives several referrals a
month from podiatrists for similar
circulation problems. "It's been a great
team effort," he said.
Diabetics in the United States undergo more
than 80,000 amputations per year. About half
the cases are partial foot amputations and
half are amputations of the leg, either
above or below the knee.
And the number of amputations is increasing
due to the aging population and increased
incidence of diabetes, Sage said. Sage is a
professor of orthopedic surgery and
rehabilitation, podiatry at Loyola
University Chicago Stritch School of
Medicine.
Diabetes is among the main risk factors of
peripheral artery disease. PAD is similar to
coronary artery disease: fat deposits clog
the arteries outside the heart or brain,
restricting blood flow to arms, legs,
stomach or kidneys. Early symptoms include
pain in the legs while walking. In the most
severe cases, PAD can cause gangrene and
require amputation.
The same factors that increase the risk of
heart attacks and strokes -- diabetes,
smoking, high blood pressure and cholesterol
-- also increase the risk of peripheral
artery disease. Lifestyle changes and
medications usually can control PAD. But a
minority of patients requires invasive
treatment.
The most invasive surgical technique is
similar to heart bypass surgery: a surgeon
takes a vein from the leg, or an artificial
graft, and uses it to route blood flow
around the blockage.
A less invasive procedure, called an
angioplasty, is done with a catheter (thin
tube). The interventionalist opens narrowed
arteries by inflating a tiny balloon at the
tip of the catheter. In some cases, a stent
(wire mesh tube) is placed to keep the
artery open.
In
recent years, interventional cardiologists
also have begun doing PAD angioplasties.
Dieter specializes in limb salvage
techniques.
The doctor begins by inserting a catheter in
a groin artery and then guides it to the
blocked artery. Reaching blockages can be
difficult. And some blockages are extensive
-- running from the hip to the knee, or even
to the ankle, Dieter said.
"It can be a technically demanding
procedure," said Dieter, an assistant
professor, medicine, at Stritch. Dieter has
had advanced training in interventional
techniques for saving limbs.
Smith, 59, wears a prosthesis on her right
leg and is able to walk with a walker or
cane. She uses a wheelchair if she needs to
go more than a block.
"I walk every chance I get," she said. "I
don't like being in a chair all the time."
Angioplasties don't always work in PAD
patients. A doctor might not be able to open
an artery, or the artery might clog up again
after the procedure. But Smith's angioplasty
worked wonders. "I could feel the blood
flow," she said. "I felt like it was a
normal leg again."
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