Cardiologist Teams Up With Podiatrist to Save Diabetic Patient's Leg

Bernice Smith of Maywood already had lost her right leg to diabetes, and now her left leg was in danger of amputation.

But there was a chance her leg could be saved if adequate blood flow could be restored. Smith's podiatrist, Dr. Ronald Sage of Loyola University Hospital, referred her to Loyola interventional cardiologist Dr. Robert Dieter, who lives in Glen Ellyn.

Using a catheter, Dieter performed a difficult balloon angioplasty in a major artery in Smith's left thigh, similar to the technique cardiologists use to open clogged heart arteries. Dieter placed a stent to keep the artery open. The procedure restored blood flow to Smith's leg, which had started to turn gangrenous because it wasn't getting enough blood.

Although Sage had to amputate Smith's toes, the rest of her leg was spared. "I can't stop thanking both of them for saving my leg," she said.

Dieter said he receives several referrals a month from podiatrists for similar circulation problems. "It's been a great team effort," he said.

Diabetics in the United States undergo more than 80,000 amputations per year. About half the cases are partial foot amputations and half are amputations of the leg, either above or below the knee. And the number of amputations is increasing due to the aging population and increased incidence of diabetes, Sage said. Sage is a professor of orthopedic surgery and rehabilitation, podiatry at Loyola University Chicago Stritch School of Medicine.

Diabetes is among the main risk factors of peripheral artery disease. PAD is similar to coronary artery disease: fat deposits clog the arteries outside the heart or brain, restricting blood flow to arms, legs, stomach or kidneys. Early symptoms include pain in the legs while walking. In the most severe cases, PAD can cause gangrene and require amputation.

The same factors that increase the risk of heart attacks and strokes - diabetes, smoking, high blood pressure and cholesterol - also increase the risk of peripheral artery disease. Lifestyle changes and medications usually can control PAD. But a minority of patients requires invasive treatment.

The most invasive surgical technique is similar to heart bypass surgery: a surgeon takes a vein from the leg, or an artificial graft, and uses it to route blood flow around the blockage.

A less invasive procedure, called an angioplasty, is done with a catheter (thin tube). The interventionalist opens narrowed arteries by inflating a tiny balloon at the tip of the catheter. In some cases, a stent (wire mesh tube) is placed to keep the artery open. In recent years, interventional cardiologists also have begun doing PAD angioplasties. Dieter specializes in limb salvage techniques.

The doctor begins by inserting a catheter in a groin artery and then guides it to the blocked artery. Reaching blockages can be difficult. And some blockages are extensive - running from the hip to the knee, or even to the ankle, Dieter said.