Dr Rundback Limb Salvage Procedure Case

Regarded as one of the nation’s most respected and admired Interventional Radiologists, Dr. John H. Rundback specializes in complex endovascular interventions—treating the most challenging cases of Critical Limb Ischemia and Peripheral Artery Disease. In addition to his work through Endovascular & Amputation Prevention, LLC located in West Orange, New Jersey.

Patient History and Consultation

This patient is a 55-year-old mother of 2 teenage children with Type 1 diabetes, high blood pressure, elevated cholesterol, and kidney transplant following a period of hemodialysis for diabetic renal failure.

She has known extensive blockage of the arteries in the lower leg and foot with prior toe amputations and now presents with a non-healing left plantar calcaneal wound and painful left 5th toe wound, and a very painful right 4th toe wound, all of which have been present for 4 months.

Prior to seeing us at American Endovascular & Amputation Prevention, she was told that no further procedures to restore blood flow are possible and that she would need below-knee amputations.

Treatment Plan

Angiography to target and treat the WOUND DIRECTED ARTERIES.

Multiplanar angiography with wound markers to assure the optimal arteries are treated as possible.

Below ankle and pedal arch intervention as appropriate to revascularize arterial obstructions in distal arteries typical of a diabetic patient. 

Two Months Later

Lessons Learned:

• Treating patients with Critical Limb Ischemia needs extreme commitment and diligence, and a willingness to treat the smaller arteries of the ankle and foot not usually addressed.
• Major amputation can be prevented in more than 80% of patients, even when they have been told that limb loss is inevitable.
• Close follow-up and continued vascular care wound care, and medical management preserves limbs.