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Foot Ulcers

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Foot Ulcers

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Chronic Limb Threatening Ischemia

What are foot ulcers?

If you are suffering from a foot ulcer, you may be diagnosed with chronic limb threatening ischemia (CLTI). Chronic limb threatening ischemia is a serious blockage of the arteries, caused by a build-up of plaque, leading to reduced blood flow to the body’s extremities. CLTI is an advanced form of peripheral arterial disease (PAD), and it causes ulcers, serious discomfort, and, if left untreated, potentially amputation.

At VIE, Dr. Cumming and Dr. Wolfe specialize in caring for patients with CLTI. We use state of the art testing and imaging to diagnose this serious condition. When necessary, we use minimally invasive procedures to treat CLTI and PAD to heal wounds and preserve affected limbs.

What are the risk factors for developing chronic limb threatening ischemia?

Risk factors include:

  • Age (especially men over 60 and women after menopause)
  • Smoking
  • Diabetes
  • Obesity
  • Sedentary lifestyle
  • High cholesterol
  • High blood pressure
  • Kidney disease or failure
  • Family history of vascular disease
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What are the symptoms of chronic limb threatening ischemia?

You may be diagnosed with chronic limb threatening ischemia if you have any of the following symptoms:

  • Toe or foot sores, infections, or ulcers that aren’t healing, or healing very slowly
  • Severe pain in foot when lying flat or in bed
  • Cold feet
  • Shiny, smooth, dry skin in the legs or feet

What should I do if I was diagnosed with chronic limb threatening ischemia?

Chronic limb threatening ischemia is a condition that requires immediate attention and treatment to restore blood flow to the affected area or areas of the body.

What are the treatment options for chronic limb threatening ischemia?

The treatment plan for chronic limb threatening ischemia often varies, but the overarching goal is to improve blood flow to salvage the limb and reduce pain.

Possible treatments for CLTI include:

  • Toe or foot sores, infections, or ulcers that aren’t healing, or healing very slowly
  • Medication: many medications can be prescribed to attempt to prevent further development of the disease and to reduce the effect of risk factors like diabetes
  • Endovascular treatment: minimally invasive surgical procedures such as angioplasty, atherectomy, and stenting are all procedures we perform at VIE
  • Arterial surgery: bypass treatment, or amputation (note: VIE does not perform amputations)

Is there an alternative to surgery or amputation?

Endovascular treatments are minimally invasive surgical procedures that can be done in our outpatient facility, eliminating the need for a hospital visit or overnight stay.

Dr. Wolfe and Dr. Cumming will partner with you and/or your existing care team to determine if you’re a candidate for endovascular treatment.

What are the benefits of endovascular treatment for critical limb ischemia?

Undergoing endovascular treatment for chronic limb threatening ischemia will greatly improve your quality of life, significantly reducing any pain caused by the affected area, as well as healing any open wounds and reducing the risk of a possible amputation.

How is endovascular treatment performed?

A local anesthetic is administered, and then access to the artery is achieved by making a small skin incision. After performing an angiogram (taking pictures of the arteries), wires and tubes (catheters) are used to get to the area of narrowing/blockage.

Treatment of the narrowed or blocked artery can include one or more of the following:

  • Angioplasty: A balloon temporarily inflated inside a blocked artery
  • Atherectomy: A medical device used to remove plaque in the artery
  • Stenting: A tiny tube permanently placed in the artery to keep it open
  • Venous arterialization: A new advanced way of providing blood flow to the foot using veins

We will determine the best treatment course for you based on a variety of factors. Once treatment is completed, all equipment is removed (except for any stents). A closure device may be used to seal the hole in the artery. The incision is tiny, so stitches are usually not needed.

Am I a candidate for endovascular treatment?

If you exhibit any of the listed symptoms above, as well as associate yourself with any of the risk factors, you should schedule an appointment with us to evaluate your symptoms and determine if treatment is right for you.

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Figure 1. Endovascular reconstruction of the pedal loop and plantar arteries.