Flint Hills Heart, Vascular and Vein Saves Limbs to Enhance Lives

By Sarah Gooding
Thursday, December 21, 2017

New advancements in technology and treatment options for peripheral arterial disease significantly reduce the need for amputation.

Raymond Dattilo, MD, FACC, opened Flint Hills Heart, Vascular and Vein in 2013.

Following a cardiac event, most physicians recommend that patients increase their activity level, but sometimes this poses a challenge.

It was a trend Raymond Dattilo, MD, FACC, noted early in his career, which began in 1988, in Topeka.

“As a cardiovascular specialist, I spent most of my time treating heart disease,” Dr. Dattilo says. “One of the things I noticed was people would come in with a heart attack and we would put them on an exercise program, but when they would walk, their legs would hurt.”

A New Approach

Dr. Dattilo opened Flint Hills Heart, Vascular and Vein, in Manhattan, Kansas, four years ago, and said the culprit behind the leg pain was peripheral arterial disease (PAD).

“Many patients had blocked arteries in their legs,” Dr. Dattilo says. “Plaque builds up in the arteries, and the most common manifestation of PAD is that patients have some discomfort in their legs as they walk. It’s often chalked up to aging, but it’s actually a disease.”

“PAD is the same as heart disease,” says Shawn Colby, head nurse at Flint Hills Heart, Vascular and Vein. “The symptoms are the same in a heart attack, except they are felt in the legs.”

As Dr. Dattilo gained more knowledge and skill in opening blocked arteries, he became concerned about the disability associated with PAD and related critical limb ischemia resulting from advanced PAD, which puts patients at an elevated risk of losing a limb.

“Diabetics comprise 70 percent of amputations,” Dr. Dattilo says. “One of the complications of diabetes is vascular disease, and those with diabetes have higher rates of heart attack, stroke and limb loss. Additionally, the smaller arteries in the calves, ankles or feet of people with diabetes are harder to open.”

“When blood doesn’t flow, wounds progress from simple wounds to complex wounds to infections in the bone,” Colby says. “We try to prevent that by opening arteries to allow blood flow to get down there.”

PAD Awareness

Traditionally, many symptoms of peripheral arterial disease (PAD) have been written off as natural parts of aging.

“People who walk for a certain distance and then develop cramps in their calves, thighs, hips or buttocks can develop such severe pain that they have to stop and rest for five to 10 minutes,” says Shawn Colby, head nurse at Flint Hills Heart, Vascular and Vein. “After that time, the pain typically diminishes or goes away.”

Often cramping and muscle pain leads to orthopedic referrals rather than to a cardiologist, lengthening what could be a fairly quick diagnosis, treatment and almost instantaneous improvement.

The team at Flint Hills Heart, Vascular and Vein is working to get the word out that this, along with cramps in the foot or leg when lying flat, can be symptomatic of PAD, as can wounds or swelling in the lower extremities, gangrene and pain at rest.

In the case of PAD, other diseases both mirror and multiply the risk factors.

“Diabetes is at the top of the list of risk factors for peripheral arterial disease,” Colby says. “History of smoking, uncontrolled high blood pressure, high cholesterol and sedentary lifestyles are also toward the top of the list.”

Raising awareness about both the symptoms of PAD and the treatment options is a high priority for the Flint Hills Heart, Vascular and Vein team.

“Part of what I do is raise awareness in the community and educate other physicians about PAD and about how there is something they can do to help their patients,” says Raymond Dattilo, MD, FACC, Flint Hills Heart, Vascular and Vein.

Preventing Limb Loss

Advances in technology within the past decade now allow physicians to open blocked arteries and salvage limbs, significantly reducing amputation rates and improving longevity and quality of life.

“I wanted to focus on patients with critical limb ischemia to prevent patients from losing their legs,” Dr. Dattilo says. “When older patients lose a limb, only about 40 percent are able to walk again, and the mortality rate is 50 percent in the year following the limb amputation.”

Flint Hills Heart, Vascular and Vein prides itself on being Kansas’ premier center for amputation prevention, and the staff utilizes state-of-the-art technologies, along with equipment such as an intravascular ultrasound machine, a hyperbaric chamber and various devices to remove plaque from arteries.

Since the first arterial procedure took place at the clinic on Oct. 28, 2013, the fusion of technology and expertise has drawn roughly 1,000 patients for arterial procedures, as well as an additional 500 for venous procedures. The clinic also boasts a limb salvage rate of more than 90 percent, well above the national benchmark of 80 percent.

Venous Treatment Options

While not as life-threatening as peripheral arterial disease, venous insufficiency and venous reflux diseases impact more people and can lead to varicose veins, swelling in the veins or limbs, cellulitis and debilitation.

“The legs are most affected by venous disease because the blood has to travel against gravity,” says Raymond Dattilo, MD, FACC, Flint Hills Heart, Vascular and Vein. “The valves that push blood back toward the heart can fail, and built-up blood in the veins then causes swelling, wounds or ulcers.”

“We do a special venous reflux study test here, which assesses the valves in the veins to make sure they’re OK,” says Shawn Colby, head nurse at Flint Hills Heart, Vascular and Vein. “The tests can also catch hereditary conditions such as May-Thurner syndrome.”

Treatment options are available and can financially save both patients and the healthcare system significantly in the long run.

If concerns arise, the team can perform an outpatient radio-frequency ablation, which involves catheterization of the vein and closing it down from the inside through a very small opening.

“It makes a huge difference,” Colby says. “We’ve seen a vast improvement in wound healing.”

Comprehensive Care

The incorporation of a wound clinic helps the staff members of Flint Hills Heart, Vascular and Vein treat wounds resulting from reduced blood flow, as well as other underlying problems.

“In addition to diagnosing and treating vascular disease, we also have the wound clinic inside the building,” Dr. Dattilo says. “That’s because 85 percent of people who have limb amputations because of poor circulation have a wound that initiates the whole sequence of events. I see them in my wound clinic, and we work to triple the blood flow and heal the wound.”

Additionally, monitoring the wound provides insight into the patient’s circulatory health.

“If the healing of a wound stalls, we typically complete an ultrasound; and if the arteries have closed, we will reopen them again,” Dr. Dattilo says.

The comprehensive process makes both immediate and long-term differences.

“We’ve seen a vast improvement in wound healing,” Colby says. “The most important aspect of wound healing is blood flow. The second thing is to reduce swelling. Facilitating both of those will enhance wound healing tremendously.”

The clinic’s hyperbaric oxygen chamber is used to treat patients with difficult-to-heal wounds such as infections in the bone.

Dr. Dattilo says the continuity of care provided at Flint Hills Heart, Vascular and Vein, as well as the family atmosphere of the clinic, brings patients from all over Kansas and some surrounding states.

All procedures are done on an outpatient basis, with invasive procedures scheduled in the morning hours and wound treatment or other appointments typically scheduled in the afternoon.

Additional information about Flint Hills Heart, Vascular and Vein, as well as resources about arterial and venous diseases are available at FlintHillsVascular.com. To schedule an appointment with the clinic, please call 785-320-5858.