Overview of Program
This unique program brings together physicians from multiple specialties, including vascular and endovascular surgeons, to treat patients with vascular diseases that can potentially lead to amputation of a limb.
Catheter interventions or surgery on blocked or dilated arteries are performed to restore blood flow to the legs, and prevent rupture of dilated arteries. A specialized team dealing with foot problems in diabetes patients creates individualized treatment plans. These include infection control with antibiotics, improvement of blood flow to the limb, limited removal of dead tissue, and healing support by casts and specially designed boots or shoes.
Early treatment is essential
Patients often reach Cleveland Clinic Abu Dhabi at a late stage, when a significant amount of foot tissue is already lost and infection has already started. Outcomes are significantly improved when patients seek help for the early signs of disease, such as leg pain, discoloration of the foot or leg, and small wounds or ulcers of the foot.
Only in the early stages can minimally invasive methods successfully be applied to avoid amputation.
What We Treat
Peripheral vascular disease affects the arteries supplying blood to the legs. It can lead to severe leg pain and tissue loss, and can result in amputation. The recognized causes include diabetes, hypertension, high cholesterol and smoking. These factors can cause an inflammation in the arteries, which leads to the blood vessel closing or dilating.
Vascular obstruction and aneurysm
In the first case (obstruction) the blood cannot reach its destination, such as an organ, muscle or skin, causing lack of oxygenation and dysfunction or tissue loss. In the second case (aneurysm) the vessel may dilate up to a point at which it may rupture. Vascular or endovascular surgery techniques aim to reestablish effective blood circulation for severe obstructions, or avoid blood vessels rupturing in the case of an aneurysm.
Diabetic foot syndrome
Diabetes leads to a particular type of vascular disease, that can cause open wounds and ulcers that are difficult to treat. This is a serious problem in the GCC region, where the incidence of diabetes is high, and early diagnosis and treatment is essential.
Diagnosis & Treatment
Diagnosis for patients affected by arterial peripheral obstructive disease or diabetic foot syndrome includes a thorough clinical vascular exam, Doppler ultrasound study, tissue oxygenation measurement, and wound care assessment. The main symptom is leg pain, and patients will often have tissue loss and open leg wounds or ulcers.
Infection control and surgical procedures
In some cases, treatment begins by controlling any infection in the foot, which may require surgery on affected areas, and sometimes the amputation of toes. This is the first step to avoid the infection spreading.
Next is an assessment of whether arterial obstructions are present. Preferably, the blockages are treated with non-invasive techniques such as catheter-based artery dilatation (angioplasty) using balloons and stents, or recanalization (atherectomy), using drilling and suctioning devices to remove deposits from the artery. For the most extensive blockages, bypass surgery may be needed, and is performed with the most advanced materials and techniques.
After surgery, the patient will be referred to the outpatient clinic to prevent the disease recurring, including podiatry, orthotic support, and the wound care team.
Patients with peripheral aneurysms are treated with remote closure using catheter techniques, such as covered stents, or by surgical resection and implantation of a synthetic graft/tube.
The multidisciplinary team works in close coordination to treat tissue damage and repair circulation. Caregivers involved in patient care for this program are:
- Vascular and endovascular surgeons
- Wound care nurses
- Specialized vascular nurses
- Vascular scientists
- Ultrasound specialists
- Infectious disease consultants
On all levels, special care coordinators and administrators are involved.