Inova's Limb Preservation Program
Limb loss has profound implications for quality of life and long-term survival. The goal of Inova's Limb Preservation Program is to reduce symptoms, improve function, protect limbs from amputation and prevent death from cardiovascular disease.
Our program combines the expertise of vascular surgery for restoring blood flow alongside advanced wound healing therapeutic options. This provides our patients with a wide range of options when treating vascular disease. While early intervention yields the best results in being able to preserve limbs, we also successfully treat advanced disease where patients have been told amputation is their only option.
Call 571-472-4600 to learn more and schedule an appointment.
Our Approach to Treatment
Patients at high-risk for losing a limb are seen at the Inova Vascular – Fairfax office, located in the Inova Specialty Center (across from Inova Fairfax Hospital) for a comprehensive assessment. That includes an evaluation by both a vascular surgeon and our wound healing specialist in a single visit.
The level of complexity and nature of the underlying disease determine whether follow-up visits will continue at the Inova Vascular – Fairfax office or in one of our four Inova Wound Healing Centers, under the care of Vickie Driver, DPM, our wound healing specialist.
Most patients require weekly or biweekly follow-up visits, which can be done onsite at one of our Wound Healing Centers – located throughout Northern Virginia. Patients return to the Inova Vascular – Fairfax location for "remission" visits (every 2, 3, or 6 months). Remission visits continue for patients whose condition has stabilized but who remain at risk for limb loss.
Limb Preservation FAQs
What are the underlying conditions that lead to losing a limb to amputation?
Peripheral artery disease, or PAD, is a common circulation problem where buildup of atherosclerotic plaque in the arteries causes reduced blood flow (and reduced oxygen) in the toes and legs. Left undiagnosed or untreated, PAD can lead to the more severe disease known as critical limb ischemia (CLI). Without diagnosis and intervention, CLI may result in chronic, nonhealing wounds in the lower limbs, which can then progress to gangrene, amputation and significant disability.
PAD progresses more rapidly in patients with diabetes. Their risk of developing CLI is four times higher.
Coronary artery disease (CAD) results when cholesterol and fatty deposits build up and narrow the arteries in the heart – a process known as atherosclerosis. If you have PAD, you are at increased risk for CAD. Similarly, patients with heart disease are at increased risk for PAD.
Other risk factors for both CAD and PAD include smoking, hypertension, obesity and kidney disease such as renal failure.
I’ve already been told I need to have a limb amputated. What should I do?
The most important step is to get a second opinion. This is especially critical if you have not had an ultrasound test to check your circulation or an arteriogram to take an X-ray of your circulation. In many cases, we can provide treatment to avoid limb loss.
Advances in endovascular techniques have greatly improved the capability to successfully treat critical limb ischemia (CLI) and avoid amputation. This is true even for older patients and those with severe comorbidities including diabetes, renal failure and failed prior interventions. The sooner you are evaluated, the better the chance to save your limb.
Inova's vascular and wound healing teams offer a wide range of interventions for every stage of vascular disease. Our physicians integrate the latest research and knowledge in medical management, diagnostic testing and imaging, minimally invasive procedures and mastery of complex vascular surgeries. Ours approach involves a network of experts tailored to each person’s unique needs.
Treatment for Poor Circulation
Minimally invasive procedures such as angioplasty and stent placement, as well as state-of-the-art bypass techniques such as Distal Venous Arterialization (DVA), are all methods we use to improve circulation.
Potential candidates for DVA include people with severe pain in their legs and feet while not moving, non-healing wounds or gangrene, who have been told they have limited options for restored blood flow.
Vascular surgeons at Inova Heart and Vascular Institute (IHVI) were among the first in the world to demonstrate that DVA can be a successful intervention for patients with critical limb ischemia (CLI) in limbs that otherwise might be viewed as unsalvageable. IHVI is one of just a few medical institutions around the globe offering this intricate procedure.
DVA re-establishes blood flow into the deep veins of the lower leg and foot to get blood to the tissues. Valves in the veins are disrupted so the blood flowing in a "reverse" direction is not stopped and can reach tissue through the capillary bed. This is accomplished in combination with a bypass technique – distal vein patch bypass – that was developed by Richard Neville, MD, Director of Inova Vascular Services, Associate Director of IHVI and Vice Chairman of the Inova Department of Surgery.
Treating non-healing wounds is essential to help avoid the need for amputation. Inova offers four state-of-the-art Wound Healing Centers where a team of experts dedicated to rapid and complete healing provides the latest advances in wound care, close to home.
Grafting of Skin Substitutes
Biologic and synthetic skin substitutes are used to cover non-healing wounds and aid in wound closure by providing lost epithelium, stimulating skin regeneration and reconstituting full-thickness skin.
Hyperbaric Oxygen Therapy (HBO)
HBO is a highly effective, safe treatment during which 100% oxygen is inhaled by a patient for short periods of time in a pressurized chamber. Breathing 100% pure oxygen increases the amount of oxygen available to your body's tissues and helps the body heal, fight off infection, decrease swelling and grow new blood vessels.
Studies have shown that certain physical problems, including non-healing wounds and gangrene, respond exceptionally well to HBO treatments.
Platelet-rich Plasma (PRP)
PRP uses a patient's own cells to promote healing. We cover your wound with a platelet-rich patch made from your white blood cells.
- Diabetic footwear
- Offloading boots
Vascular Risk Reduction
Our vascular specialists provide evaluation and management of risk factors using specialized vascular diagnostic tests and imaging that help in optimizing medical management for patients with known PAD. Our team has the experience and expertise to assist with management of risk factors as well as the use of anticoagulants and antiplatelet medications.
• Dr. Neville is Director of Inova Vascular Services, Associate Director of Inova Heart and Vascular Institute (IHVI) and Vice Chairman of the Inova Department of Surgery.
• Dr. Driver is System Medical Director of the Inova Wound Healing Centers and Director of Wound Care and Hyperbaric Research for IHVI.
We also collaborate with infectious disease experts, plastic surgeons, podiatrists, endocrinologists, nephrologists, physical and occupational therapists and other specialists as needed.
We currently offer both in-person and virtual consultations at our Fairfax location.