I have severe peripheral vascular disease. My dr is trying his best to prevent having to take away my limbs.?

Question

I know have approx. 15 stents in my legs and 10 in my heart area. Will my body allow me to continue to fight this battle or will there be a time when I just have too many stents?

P.S. Thanks to Dr Samuel Demaio for helping me fight this battle.

Thank you for your nice words.

Answer 1

I truly empathize with you. Having said that, let me give you the following info:


In most cases, the presence of PVD is a sign of systemic atherosclerosis, which puts these patients at high risk of stroke, myocardial infarction, and cardiovascular death. Risk factors for PVD include smoking, hypertension, hyperlipidemia, diabetes, family history of cardiac or vascular disease, obesity, and sedentary lifestyle


Conservative treatment options, including cessation of tobacco use, exercise programs, and modifications in lipoprotein and cholesterol abnormalities, are the first line of defense against PVD.


Have you and your Dr consider other options than amputation?


1) Angioplasty (Percutaneous Transluminal Angioplasty)

TABLE 1

Angioplasty vs. Bypass Surgery
for PVD of the Lower Extremities

Angioplasty

Advantages
Offers faster recovery
Requires shorter hospital stay
Requires no general anesthesia
Maintains all options for extremity revascularization
Allows for preservation of the saphenous veins for
future use (for extremity or coronary artery bypass)
May be repeated if necessary
May be combined with surgery to improve inflow or
outflow of surgically placed grafts

Disadvantages

Lower primary patency rates
Reinterventions due to restenosis may be necessary
Of limited use in the presence of multiple-level stenoses
Cost-benefit ratio for severe advanced PVD is debatable


2) Coronary Artery Bypass surgery (CABG)

Advantages

Considered the gold standard
Has good long-term patency
May be preferable to treat multiple stenoses if venous conduit available

Disadvantages

A higher rate of morbidity
Potential systemic complications
Typically requires general anesthesia
Requires harvesting of saphenous veins and
upper extremity veins, precluding their use
for coronary artery bypass


3) Antiplatelet/antithrombotic therapy also may be considered for use in these patients. Studies have shown that aspirin therapy may modify the natural history of chronic lower extremity PVD. It also has been suggested that use of aspirin may prevent death and disability from stroke and myocardial infarction secondary to underlying disseminated atherosclerosis.

I guess your Dr might have used the drug Trental among others already.


4) Percutaneous Revascularization -

Surgical bypass of severely occluded vessels has been considered the gold standard for use in symptomatic patients who do not respond to more conservative treatments.



Rapid advances in percutaneous revascularization techniques and equipment have significantly changed the patterns of vascular reconstruction, particularly when lifestyle modifications and drug therapies fai


For purposes of revascularization, PVD is considered in terms of inflow (aortoiliac) and outflow (infrainguinal) occlusive disease. In both cases, surgical revascularization represents the gold standard against which the results of percutaneous revascularization with angioplasty and stents are compared. Increasingly, combined surgical bypass and percutaneous endovascular treatment by the vascular/interventional radiologist, vascular surgeon, or interventional cardiologist are being used to optimize patient outcome while minimizing morbidity.

AORTIC REVASCULARIZATION

The iliac arteries are technically among the easiest vessels to approach percutaneously and are the largest peripheral lower extremity vessels with the highest flow rates. These factors optimize the outcome of percutaneous transluminal angioplasty (PTCA) and stenting (Table 2). Surgical bypass has a durable high rate of patency, reported as 93 percent at 42 months in a recent study,but it is a major surgical procedure with potential for systemic complications in patients with preexisting significant comorbid conditions

Table 2

Characteristics of Best Candidates
for Angioplasty

Stenosis, rather than occlusion
Short-segment disease
Noncalcified lesions
Concentric stenoses
Large-vessel involvement
No coronary comorbidity or treated coronary disease
No diabetes
Claudication
Normal renal function
Good run-off (i.e., patent vessels distal to treated
lesion)



NOTE: Patients who have had their saphenous veins harvested
for coronary artery bypass may be better candidates for
percutaneous transluminal angioplasty than for synthetic
bypass grafting, depending on the lesion and location


You might be interested in the info below :


Directory of physicians who perform endovascular techniques, patient information about PVD and details about the Legs for Life National Screening Week for PVD Leg Pain are available through the Society of Cardiovascular & Interventional Radiology, 10201 Lee Hwy., Suite 500, Fairfax, VA 22030; telephone, 800-488-7284; Web site, http://www.scvir.org


Are you a good candiate for amputation? Remember, diabetics do not heal very well.
You are indeed faced with an arduous life decision?

There are a lot of questions and answers you have to consider.:

Ischemia to lower limbs would eventually lead to gangrene and thus amputation. How long can you tolerate the pain and discomfort from claudication ? How many more stents can your extremities take? How long will this present stent remain patent? Is there any alternative solution to my problem aside from limb loss?


Of course, it's easier for me to say; because I'm not in your shoes. But if I were you, I'll take my chances with every possible option short of amputation. No matter what they say about being wheelchair -bound; I don't think you'll ever get adjusted to that kind of substandard life. You'll be so devastated by the loss of your integrity and dignity as a vital individual.

My prayers are with you!!! Pls post again to let us know about your decision.

Answer 2

Oh, my heart goes out to you..........sincerely it does. I cannot imagine what you are going through.

I admire you for keeping up the good fight.

I do think that your body will reach a point where there is nothing else that can be done.....too many stents, risk of infection too high.

You could develop an infection/wound around stent site and because of your PVD have little to no chance of those sites healing.

You don't want to risk your life with an infection.

I believe that you and your physician will know when enough is enough. I pray that somehow you will find the grace to deal with the knowledge that you've done all you can.

I sound so negative and I apologize. You just have an advanced case of PVD and most other physician's would have already amputated.

FIGHT, but be realistic. Remember that your life is more important than anything else. However, I know it's easy for me to say that since I am not faced with what you are.

God bless...........may you successfully beat this as long as you can.

Answer 3

nicely, a minimum of you've a significantly better idea of what's been causing a number of your discomfort. 12 hours isn't gonna kill you. nor is vascular affliction. once you're clinically determined, you'd be able to get some help from the gadget. The stupid county position is a sturdy position to have your medical archives documented once you observe for help & foodstuff stamps, then initiate a case with social safe practices for incapacity reward. it isn't a large number of money, notwithstanding it truly is more desirable than you have become now, top? inspect those 12 hours as an funding on your destiny. I actual have heart complications too. i don't like medical doctors, hospitals, or drugs. it truly is why I discovered a thanks to eat different & take aspirin so I gained't ought to bypass lower than the knife. we ought to continuously commence a set so as that if one human beings would not verify in, the others contained in the team can notify the Y/A consumers that we died! I cope with my melancholy with somewhat a humor...you are able to a thanks to snort about this. it isn't as undesirable as you imagine it truly is as we talk. once your techniques is comfortable, your body will actually save on with & you'll hit upon a astounding %. for your self. be affected individual with your self. you're about to enter a sparkling portion of your existence. i'm satisfied to take heed to you took the first step. save searching ahead to day after today & enable the previous bypass, ok? I see a lot of human beings have sturdy issues to share with you. I too have wanted to bypass to reformatory at situations or bypass to sleep & not awaken. dangle in there & save the religion.

Answer 4

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