Diabetes and vascular conditions like peripheral arterial disease (PAD) are the two leading causes of poor blood flow leading to ischemia and other complications that require amputation of a limb.1 Racial and socioeconomic disparities remain an issue in the field of amputation: black patients with PAD, for example, are two to four times more likely than white patients with PAD to undergo a limb amputation, and are significantly less likely to receive attempted limb-salvaging care before they do.2 Temple’s Limb Salvage Center, directed by Eric T. Choi, MD, Chief of Vascular and Endovascular Surgery, is attempting to reduce those disparities in the Temple community through one-stop care, outreach and aggressive therapies that provide a better chance of preventing amputation for patients with vascular disease, diabetes, non-healing wounds and other issues.
“Over the past 20 years, the amputation rate has gone down nationally in all groups—except for young black men, ages 40 to 59. This is critically important in our community,” notes Dr. Choi. “The community surrounding Temple is approximately 60 to 70 percent black, so we are making it a priority to address these issues and do outreach.” The community also has many people with diabetes and many elderly patients, both groups with elevated risk for limb-threatening conditions. The Center, now in its fourth year, is piloting treatment, awareness and education initiatives in the community on a small scale, and looking to expand these efforts further.
The Center, the first of its kind in the region, is a model that Temple hopes will help other institutions tackle similar issues. Patients receive immediate diagnostic evaluations, which may include blood-flow, nerve function and biomechanical testing as well as advanced imaging like CT angiography and radionuclide scans. Those with limb-threatening infection, ischemia and other symptoms are seen by specialists in fields as varied as vascular and endovascular surgery, nephrology, plastic surgery, physical therapy and interventional radiology—all in the same location, and often on the same day. These specialists offer a range of treatment options, from traditional bypass surgery to minimally invasive revascularization, grafting with bioengineered skin, and, if necessary, foot-sparing partial amputations.
“In order to have an impact, you have to make your services easily accessible to the patient,” says Dr. Choi. “Once a patient starts having problems, they can snowball quickly into something that requires a leg amputation. Instead of having these patients go to different specialists and locations for their care, we try to make it much more accessible with a single location.”
The Center focuses not only on integrated care delivery but also on the latest vascular research, piloting investigational therapies like bone marrow stimulation and gene therapy. The LSC is currently the only program in the region to prevent limb amputation through angiogenesis from bone marrow-derived stem cells, with one trial completed last year and two ongoing.