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SAN ANTONIO
MEDICINE

Diabetes, PAD and Preventing

Lower Leg Amputations

By Jeffrey Martinez, MD

November is Diabetes Month. Kin to diabetes is Peripheral Ar- oration of his foot. The day after his surgery, he walked a full
tery Disease (PAD), and as a vascular surgeon who treats diabetes mile with no pain.
patients from the San Antonio area daily, I welcome the opportunity - Trinidad, who suffered from plaque buildup in his legs, proudly
to spread an understanding of diabetes and PAD. PAD is a circula- announced after undergoing the procedure for his left leg, that
tory ailment; it is the narrowing of peripheral arteries due to ather- he could lift the leg properly and no longer dragged his foot.
osclerosis (plaque buildup on arterial walls), decreasing blood flow
to legs, feet and toes. Complications from untreated PAD include What can at-risk patients do to save their limbs? The first step is
pain, nonhealing ulcers, gangrene and amputation. awareness – of the risk factors, symptoms, and new therapies
like endovascular procedures. Also:
Who gets PAD? Pad affects as many as 12 million Ameri- - For at-risk populations, (particularly those with diabetes), proac-
cans, and major risk factors include type 2 diabetes, age, obe- tive screening tests, such as a pulse check or ultrasound, will find
sity, high blood pressure, high cholesterol and smoking. In problems early.
South Texas, PAD is particularly evident in the diabetic His- - Annual (or more frequent) foot care can detect or prevent ulcer
panic American population. development. Often, people with PAD will be unaware of ulcers
and other lower leg injuries for days or weeks because they don’t
A relatively new outpatient procedure is becoming a standard op- feel them. Regular care ensures detection before it’s too late.
tion for diabetics, PAD sufferers and their physicians to consider. - If PAD symptoms worsen to where amputation is recom-
Endovascular procedures are minimally invasive, fluoroscopic- mended, patients should ask their doctors about alternatives.
guided radiologic procedures. They pose minimal risk to the patient, That’s where an endovascular procedure often comes in.
are typically quicker and offer reduced recovery time. Endovascular
procedures are real options for PAD sufferers, and treat vascular Over the last year, more than a thousand patients in the San An-
disease down to the toe. These procedures give patients options that tonio area alone have had their toes, feet and lower legs saved by
prevent amputations and keeps them whole. Patients are often dis- endovascular procedure. Our hope is that greater awareness of this
charged the same day and use moderate sedation or local anesthesia option will save even more limbs from amputation.
rather than general anesthesia like more invasive procedures.
The best way to understand the effect PAD (and endovascular Dr. Jeffrey Martinez, MD, is managing physician at Modern Vas-
procedures) can have on lives is to hear about the procedure from cular’s new second clinic in San Antonio. A native of San Antonio
the patients themselves. For example: and a board-certified vascular surgeon with additional training in en-
- Patricia, whose podiatrist had treated her for neuropathy pain for dovascular surgery, he attended Texas A&M University and received his med-
years complained that at night her chronic pain would get worse ical degree from the University of Texas Health Science Center at San Antonio.
when she sat and elevated her legs. Severe pain in her toes would He completed his residency in general surgery in San Antonio as well as his
keep her awake at night. Her doctor finally referred her for eval- vascular fellowship at the University of Tennessee Medical School in Memphis,
uation and an endovascular procedure. It restored her circulation TN. After serving eight years on active duty in the U. S. Navy, Dr. Martinez
– down to the toe – and she felt immediate relief from pain. has been practicing in San Antonio since 2001. Dr. Martinez is a member of
- George, a diabetic for 30 years, who had long-standing problems the Bexar County Medical Society. https://modernvascular.com/modern-vas-
with his legs, reported he felt tingling and burning, and discol- cular-of-san-antonio-lexington/.

30 San Antonio Medicine • November 2020