Endovascular Limb Salvage

Your surgeon might recommend endovascular limb salvage if you’re dealing with vascular conditions like peripheral arterial disease, diabetic arterial disease, venous pressure, venous hypertension, arterial insufficiency, or critical limb ischemia. These conditions can lead to blockages in the arteries, cutting off blood flow to the limbs and putting them at serious risk for non-healing wounds, infections, and, ultimately, amputation. Endovascular limb salvage is a technique used by vascular surgeons to restore blood flow (revascularize) to the affected limb—sometimes all the way down to the toes—to help wounds heal and give the patient a shot at saving their limb.

Getting ready for endovascular limb salvage surgery typically involves the following steps:

• A review of your medical history and a physical exam to identify any health issues that need to be addressed before the procedure.
• Routine diagnostic tests, like blood work and duplex/Doppler ultrasound scans, to evaluate blood flow to the limb and assess the severity of the blockage.
• You’ll be asked about any allergies to medications, anesthesia, or latex.
• Let your doctor know about any medications or supplements you’re taking, as well as any conditions you have, such as heart or lung disease.
• You may need to stop taking blood thinners, anti-inflammatories, or certain supplements for a week or two before the surgery.
• Avoid alcohol and tobacco for at least a few days before the procedure and for several weeks afterward.
• Don’t eat or drink anything (including water) for at least 8 hours before the surgery.
• You might be asked to shower with an antibacterial soap beforehand to lower the risk of infection.
• Arrange for someone to drive you home afterward, as you won’t be in any condition to drive yourself.
• You’ll need to provide informed consent after your surgeon explains the procedure in detail.

Endovascular limb salvage usually involves a minimally invasive procedure called angioplasty—a technique used to push plaque (fatty deposits) against the walls of an artery to clear blockages. Here’s a general breakdown of how it works:

• You’ll lie on your back on the procedure table, and local anesthesia will be administered to numb the area.
• A small incision is made in the groin or wrist, depending on where the narrowed blood vessels are located.
• A special dye is injected into your bloodstream to help visualize blood flow through the arteries, and X-rays are taken to guide the procedure.
• Using these real-time X-ray images, your surgeon inserts a thin guidewire through a blood vessel in the groin area and threads it up to the blocked artery.
• A balloon catheter (a thin, flexible tube) is then guided over the wire to the narrowed section of the artery.
• The catheter has a deflated balloon at its tip, which is inflated once it reaches the blockage.
• As the balloon expands, it compresses the plaque against the artery walls, widening the artery and restoring blood flow.
• In some cases, your surgeon may also place a small wire mesh tube called a stent alongside the balloon catheter. The stent helps keep the artery open and prevents it from narrowing again in the future.
• Once the artery is widened, the balloon and catheters are removed, but the stent stays in place to ensure the artery remains open and allows proper blood flow to the limb.

After endovascular limb salvage, your recovery and post-procedure care will generally include the following steps:

• You’ll be moved to a recovery room where your nurse will keep an eye on your vital signs as you wake up. You’ll be able to start walking within 6 to 8 hours after the procedure.
• Most patients can go home the same day, but some might need to stay in the hospital for up to 2 days, depending on their condition.
• You might feel some pain, swelling, or discomfort at the incision site, and your doctor will prescribe medications to help manage these symptoms.
• To lower the risk of blood clots, you’ll be encouraged to walk regularly. Your doctor may also prescribe blood-thinning medications as a precaution.
• You’ll receive instructions on how to care for the incision site, including keeping it clean and dry, and when it’s safe to bathe.
• Avoid strenuous activities, heavy lifting, and driving for a specific period. Gradually ease back into your normal routine as you recover.
• Most people can return to work and resume daily activities within a couple of weeks, though some restrictions may apply.
• Make sure to take all prescribed medications and consider lifestyle changes like quitting smoking, exercising regularly, maintaining a healthy weight, and eating a balanced diet to support your recovery and overall health.
• Follow-up appointments will be scheduled to track your progress and ensure everything is healing as expected.