Doylestown Health’s Vascular Surgery team gathers after performing their first Transcatheter Arterialization of Deep Veins System (TADV) procedure using the LimFlow® System. From left are Omar Toubat, MD, PhD, resident in the Integrated Cardiac Surgery Program at the Hospital of the University of Pennsylvania, and Doylestown Health Vascular Surgery Operating Room (OR) team members Scott Malinowski, RT, radiology tech; Lisa Mothes, BSN, OR nurse; Paul J. Foley III, MD, vascular surgeon; Christin Cantwell, BSN, OR nurse; Jennifer Costello, RT, radiology tech.
Doylestown Health’s Vascular Surgery team has introduced LimFlow, a new, minimally invasive treatment designed to help people avoid major lower limb amputations caused by critical limb-threatening ischemia (CLTI).
Using this novel concept, surgeons repurpose a healthy vein to function as an artery, bypass blocked arteries, and restore blood flow to the lower leg and foot. Since the first case, our skilled vascular surgeons have given four more patients a chance to avoid amputation using the LimFlow® System.
Understanding Critical Limb-threatening Ischemia
An advanced stage of arterial disease, CLTI occurs when plaque buildup along the inner artery walls cuts the flow of oxygen-rich blood to your limbs.
Symptoms of CLTI may include:
- Severe pain, even at rest
- Tissue death, gangrene
- Wounds that don’t heal
“There’s a spectrum of severity with peripheral artery disease, and CLTI is the most critical stage,” says Paul J. Foley, MD, a vascular surgeon at Doylestown Health. He notes that individuals with CLTI have extensive blockages throughout the arteries in their legs, especially in small blood vessels below the knee and into the foot.
The following conditions are common contributors to CLTI:
- Advanced kidney disease
- Diabetes
- High blood pressure
- High cholesterol
- Smoking
LimFlow to the Rescue
The U.S. Food and Drug Administration approved Transcatheter Arterialization of Deep Veins (TADV) with the LimFlow System in September 2023. Before that, amputation was the only option in patients with advanced CLTI who were not candidates for other traditional revascularization options.
Advanced Care with a Personal Approach
At Doylestown Health's Woodall Center for Heart and Vascular Care, our fellowship-trained vascular surgeons Atul Rao, MD, FACS, and Dr. Foley combine high-level expertise and experience with a personalized approach to find the proper treatment for each person in their care.
"It is exciting for us to have a new way to help people avoid amputation either below the knee or above the knee," says Dr. Foley.
“Amputation is a life-altering surgery that limits mobility and independence, especially for people who are seriously ill,” says Dr. Rao, noting that mortality rates are higher after an amputation.
The Promise II study, highlighted in the New England Journal of Medicine, evaluated 105 patients who faced unavoidable amputation due to CLTI. Instead, they were treated with TADV using the LimFlow System.
Six months after the procedure, nearly two-thirds of the study participants were alive and amputation-free.
How TADV with LimFlow Works
“Unlike arteries, veins are less affected by plaque,” says Dr. Foley. “LimFlow works on a novel concept that allows surgeons to repurpose a healthy vein to function as an artery.”
The procedure is minimally invasive. It involves inserting catheters through two small incisions—one in the groin to access the artery and a second on the bottom of the foot to access the vein.
After threading the catheters to the area of the blockage in the calf, the surgeon uses specially engineered instruments to bypass the blockage, connecting the blocked artery to a healthy vein nearby. Then, the surgeon deploys a self-expanding stent graft to secure the connection between the artery and vein.
By rerouting blood flow through the connection, we restore blood flow to the foot and toes, according to Dr. Foley. The goal is to prevent amputation, alleviate pain, and promote wound healing.
Recovery After LimFlow
The procedure restores blood flow to the lower leg and foot, but the first four to six weeks following TADV are crucial. We watch each patient closely to ensure their lower leg and foot have sufficient blood flow," says Dr. Foley. "We want to see that wounds are healing, any infection is clearing, and the person’s pain is relieved — all positive signs of successful limb preservation.”
A Team of Experts
Doylestown Health’s fellowship-trained vascular surgeons collaborate with a multidisciplinary team of providers to care for people experiencing vascular disease.
Our experienced team performs advanced procedures using leading-edge technology in the hospital’s sophisticated Endovascular Hybrid Operating Suite.
Schedule an Appointment
To learn more about Doylestown Health’s Vascular Surgery Program, please call 215.230.6982.
About Vascular Surgery
Doylestown Health vascular surgeons offer advanced diagnosis and treatment of an array of vascular conditions. Vascular services include comprehensive diagnostic and therapeutic interventions for conditions of the arterial and venous systems. Doylestown Health’s highly experienced, fellowship-trained endovascular surgeons perform complex open surgeries and minimally-invasive endovascular treatments in Doylestown Hospital’s sophisticated hybrid operating room.
