Don’t take poor blood circulation lightly. Your primary care provider can determine whether simple treatment options like regular massages, compression socks, putting your feet up and eating better will remedy the condition.

Some cases of poor blood circulation can be a sign of peripheral artery disease, which if left untreated can damage your feet to the point of amputation and death.

Peripheral artery disease happens when plaque from high cholesterol builds up in arteries in your extremities, usually the legs or feet, making the blood vessel narrow and rigid. Blood clots can break from the plaque buildups causing complications. When this happens close to the heart or brain it can cause heart disease, heart attack and stroke.

Peripheral artery disease can advance to chronic limb-threatening ischemia (CLTI), where poor leg circulation has deteriorated to the point that your foot or part of your leg is at risk of needing amputation.

New treatment can help save limbs at risk of amputation

A new treatment, recently approved by the Food and Drug Administration (FDA), can restore blood flow and reduce risk of amputation for patients who have run out of other options, such as medication or surgery for CLTI. An estimated 1 in 5 patients with CLTI fit this description. CLTI affects up to 4 million Americans, resulting in more than 150,000 major amputations annually in the United States.

CLTI is the most serious form of peripheral artery disease and typically occurs in patients experiencing diabetes, coronary artery disease, obesity, high cholesterol and/or high blood pressure.

The primary surgical treatments to address CLTI symptoms are angioplasty or bypass surgery. In many patients, neither option is feasible because of extensive disease in the target arteries.

The treatment redirects blood flow around a blocked artery in the lower leg so blood can reach the feet. Norton Vascular Surgery, part of Norton Heart & Vascular Institute, is the first provider in Kentucky to offer the procedure.

“We’re thrilled to be able to offer our patients this first-of-its-kind procedure,” said Lauren M. Strait, M.D., vascular surgeon with Norton Heart & Vascular Institute. “It has the potential to greatly improve quality of life by reducing pain, enabling wound healing and, most important of all, preventing amputation.”

With the LimFlow System for transcatheter arterialization of deep veins, catheters are inserted from opposite directions — through a vein on the bottom of the foot, and an artery in the groin. Each is threaded through the blood vessels until they reach the area of the blood clot or other blockage.

At that point, the catheter in the artery pierces the vein, and the LimFlow device connects the two blood vessels. The vein carries oxygenated blood to the foot, then blood flow resumes its normal path back to the heart for recirculation.

Self-expanding stent grafts create a permanent conduit for blood flow from the artery into the vein.

The FDA approved LimFlow in September 2023 following a successful clinical trial.

In that study, published in the New England Journal of Medicine, 105 patients with CLTI underwent the LimFlow procedure. At six months, 76% avoided above-ankle amputation. Wounds were completely healed in 25% of patients and in the process of healing in 51%. No unexpected adverse events were reported.

Peripheral artery disease versus other vascular conditions

Peripheral artery disease and varicose veins are different conditions. Arteries carry oxygen-rich blood away from the heart out to the body, while veins return the depleted blood back to the lungs and heart for recirculation.

While peripheral artery disease is associated with blocked arteries, varicose veins typically are tied to leaking valves in the veins of the legs. Deep vein thrombosis is another condition affecting blood vessels, where clots form in veins far from the heart.

Because peripheral artery disease is caused by an underlying condition of cholesterol plaque buildup, or arteriosclerosis, treatment also means taking care of your risk for heart attack and stroke. If diagnosed early, peripheral artery disease can be managed by quitting smoking, managing diabetes and high blood pressure, lowering cholesterol and triglyceride levels in your blood, taking medication to prevent blood clots and exercising.

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When Rob arrived by ambulance at Norton Audubon Hospital, he learned the truth was far worse than a tainted meal. An aneurysm on Rob’s aorta had ruptured in his abdomen.

“I was in a life-threatening situation,” said Rob, who was 57 at the time of the emergency. “I had bled 40% of my blood into my body cavity.”

The aorta supplies blood from the heart to the body, running through the chest and abdomen. A weakening in part of the aorta wall can result in an aneurysm, an enlarged area that stretches like a balloon and can burst without warning. A ruptured abdominal aortic aneurysm (AAA) can kill very quickly.

Rob’s deep abdominal pain symptoms were not unusual for a AAA. An enlarged AAA often strikes with no symptoms. Some patients have described what may feel like a heartbeat in your stomach or near your bellybutton.

Ferenc P. Nagy, M.D., a vascular surgeon with Norton Heart & Vascular Institute, was on call when Rob arrived at the emergency room.

“A person who has a ruptured aneurysm is actively dying because there is no way for the body to stop that bleeding on its own,” Dr. Nagy said.

A burst pipe that needs to be fixed — fast

Dr. Nagy likened Rob’s situation to a pipe bursting in a house. The pipe needs to be replaced or rerouted — quickly. In Rob’s case, Dr. Nagy chose a minimally invasive procedure to insert stents rather than performing conventional surgery.

“With the stenting procedure, we’re able to realign his blood flow. We’re fitting a new pipe inside the pipe that burst on him,” Dr. Nagy said. “You essentially are diverting all of his blood flow within the new pipes back down to normal areas, and you’re preventing any blood from getting into the aneurysm.”

On his way to the hospital, Rob called his wife, Kelly Priest, at their home outside Dayton, Ohio, to tell her what was going on. She and their daughter got in the car and to make the 2½-hour drive to Louisville. En route, they talked to the staff at Norton Audubon Hospital.

“The very, very friendly and professional staff was keeping us in contact as we were on our way there,” Kelly said. “And they did mention that he was a very sick. So if the staff is telling you that [the patient is sick], you know it’s serious.”

Just before Rob’s wife and daughter arrived at 3 a.m., Dr. Nagy performed the stenting procedure on Rob. Forty minutes later, the vascular surgeon came out to give Kelly the good news, and she was able to see Rob.

At Rob’s bedside, Kelly was overwhelmed.

“Once he looked at me, tears of joy came because I knew he was alive, and we had come through this,” she said.

Few with ruptured AAAs even make it to the hospital

Rob had beaten the odds. Half of patients who have a ruptured aneurysm don’t make it to the hospital. Half of those who get to the hospital don’t make it to the operating room.

Norton Heart & Vascular Institute has a dedicated team to handle emergency cases like Rob’s, where time is critical, and a patient’s life is in the balance.

Rob’s arrival at Norton Audubon Hospital launched the team into action, and preparations started immediately for his lifesaving procedure.

“I don’t feel like there’s a better place in the city that can take care of aneurysm disease. We’ll do anything we have to do to make sure patients are well taken care of,” Dr. Nagy said.

Most people with aneurysms don’t realize they have them unless they are being examined for another reason, according to Dr. Nagy. For example, patients complaining of a kidney stone might find out that it’s actually an abdominal aortic aneurysm.

Risks factors for abdominal aortic aneurysms include age, being a current or past smoker, being male, being white, having an aneurysm elsewhere and having a family history.

Once someone has had an abdominal aortic aneurysm, they are at risk for aneurysms elsewhere and need to be monitored closely. Rob had a chance to see a doctor closer to home for his follow-up. He chose to stay with Dr. Nagy, who has since found aneurysms in both of Rob’s legs.

“I’m very confident I’ve got the right people keeping an eye on me,” Rob said.

Abdominal aortic aneurysm screening guidelines

The U.S. Preventive Services Task Force (USPSTF) recommends abdominal aortic aneurysm screenings for men ages 65 to 75 who smoked 100 or more cigarettes in their lives. Those in that age group who have never smoked may want to have a screening in consultation with their health care provider.

The USPSTF does not recommend screening for women who have never smoked and says there isn’t enough evidence to support screening of women ages 65 to 75 who have smoked 100 or more cigarettes.

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The abdominal aneurysm occurs when a portion of the aorta enlarges like a balloon. The aorta is the largest blood vessel in the body and supplies blood to the pelvis, abdomen and legs. Sometimes the AAA remains small, or it may tear or burst, causing life-threatening internal bleeding.

According to the Society for Vascular Surgery (SVS), 200,000 adults in the U.S. are diagnosed with AAA every year. It is the 10th leading cause of death for American men over the age of 55, and a ruptured AAA is the 15th leading cause of death in the U.S.

Symptoms

Abdominal aortic aneurysm often grows slowly without symptoms for most patients. If you have an enlarging abdominal aortic aneurysm, you might notice:

• Deep, constant pain in your abdomen or on the side of your abdomen
• Back pain
• Feeling your heartbeat in your stomach or a pulsing feeling near your navel (bellybutton)

AAA can be detected with an abdominal ultrasound, computed tomography (CT) scan or magnetic resonance imaging (MRI).

Risks

Many lifestyle habits and health conditions can signal a greater risk for an AAA. Those over age 50 with a history of the following are at greatest risk:

• Smoking is the strongest risk factor for AAA. It weakens the walls of the aorta and can increase the chance of the AAA.
• Age and ethnicity are also strong predictors of AAA. White people assigned male at birth are in the highest risk group.
• Conditions such as high blood pressure, diabetes and high cholesterol also put people at a higher risk for AAA.
• Family history of AAA increases your risk of the condition.

Don’t put off a check-in with your doctor if you have these risk factors or the symptoms described above.

Reviewed by Gregory C Schmieder, M.D., vascular surgeon with Norton Heart & Vascular Institute

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Carotid artery blockages cause up to a third of strokes, according to Stephen B. Self, M.D., vascular surgeon with Norton Heart & Vascular Institute.

“Not all patients need surgery right away to treat carotid disease,” Dr. Self said. “Drug therapies are often the first line of defense.”

Addressing blockages in more severe cases may require surgery. Traditionally, surgeons have treated the blockage by opening the artery through an incision along the entire neck, then removing the plaque manually — a carotid endarterectomy. A conventional stent also can be used to treat the blockage.

“However, both options have limitations and actually carry a risk of stroke during the procedures themselves,” Dr. Self said.

Reversing blood flow to reduce risk of stroke during the procedure

A minimally invasive procedure — transcarotid artery revascularization (TCAR) — has been developed in recent years for patients who face high risk of complications from traditional surgery.

Using the TCAR (pronounced TEE-kahr) procedure, physicians access the blockage through a small incision in the chest just above the clavicle bone. Blood flow temporarily is reversed so any clots are flowing away from the brain while a stent is placed in the carotid artery to stabilize the blockage.

During the blood flow reversal, oxygen-rich blood is filtered outside the body and returned to the brain through other arteries.

Silk Road Medical, maker of the TCAR device, has recognized Norton Audubon Hospital, Norton Brownsboro Hospital and Norton Hospital as TCAR Centers of Excellence. The designation is a result of excellent patient outcomes through appropriate patient selection and the well-trained and credentialed vascular specialist teams.

“TCAR is an important new option in the fight against stroke and is particularly suited for the large portion of patients we see who are at higher risk of complications from carotid surgery

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