The vascular specialists at Orlando Health Heart and Vascular Institute have launched a critical limb ischemia (CLI) program to evaluate, prevent and resolve this more complex and advanced form of peripheral arterial disease (PAD). Established a year ago, the program currently sees five to 10 CLI patients a month and uses a variety of advanced modalities to prevent amputation.
Approximately 50 percent of patients are asymptomatic, making CLI difficult to diagnose before it progresses. “Historically, CLI has been underdiagnosed and dramatically undertreated due to its asymptomatic nature — until it’s not,” says Imran Farooq, MD, a board-certified interventional cardiologist specializing in endovascular procedures and limb salvage with Orlando Health Heart and Vascular Institute. “We try to screen our cardiovascular patients over 50 with multiple risk factors like smoking, hypertension, hyperlipidemia and diabetes in an effort to catch the disease before it advances.”
The institute’s CLI care pathway combines an integrated, multidisciplinary team with a CLI coordinator who helps the patient navigate the process. Within the pathway protocol, CLI patients receive expedited labs, ultrasounds and CT scans to help pinpoint the location and extent of disease involved. A CLI provider follows up with each patient within three days of testing to discuss results, risk factors and care goals.
Depending upon the severity, specialists attempt microvascular techniques to address atherosclerotic plaque in the legs with the aim of improving blood flow to the affected area. Endovascular therapies for CLI include drug-coated balloon angioplasties, stenting and orbital/rotational and laser atherectomy. Some patients will require surgical bypass grafts, depending on the nature and extent of the disease process. When applicable, the most current, non-surgical interventions are utilized to treat CLI.
“Our CLI pathway helps us very quickly determine a patient’s needs,” says Dr. Farooq. “We have multiple treatment modalities that include specialists from vascular surgery, interventional cardiology, podiatry, wound care, plastics, infectious disease and endocrinology – all specifically focused on PAD and CLI. This allows us to treat from multiple angles to help our patients salvage their limbs and prolong their quality of life.”
Orlando Health has long been a regional leader in cardiovascular innovation with experts specializing in more than 40 heart and vascular areas. Our Cardiovascular Research Program is committed to advancing biomedical sciences and ushering in the latest technology to serve patients. Physician investigators also conduct clinical trials sponsored by the National Institutes of Health or industry innovators.
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