TriStar Health - September 06, 2016
by TriStar Centennial

When an Eastern Tennessee surgeon told him there was nothing left to do but amputate his leg, Joseph Celso just said ‘No.’  Celso, who has a long history of degenerative vascular disease, said the illness had robbed him of too much already and he certainly wasn’t going to let it take his leg.

His search led him to Brian T. Fisher, M.D., a board certified vascular and endovascular specialist for The Surgical Clinic in Nashville. Dr. Fisher is a national expert in lower extremity limb preservation using minimally invasive techniques.  

Out of Options

“My quality of life had been significantly impaired and continued to deteriorate for the past six to nine years,” said Celso.  “I not only couldn’t do the things that I love, like yard work and handy-man projects around the house, but I could barely walk, and when I did the pain was grueling because the blood flow in my legs was so significantly impaired.”

Celso had been to three or four different vascular surgeons near his home in the Knoxville area, and repeated attempts to open the blood vessels in this legs had been unsuccessful.  Finally, one surgeon told him there was nothing left to do but amputate his leg below the knee.

Celso said he immediately felt at ease with Dr. Fisher who assured him that he would do everything possible to avoid amputation.  “Dr. Fisher instilled such confidence in me and has a terrific bedside manner,” he said. “He explains everything thoroughly and is very approachable.”

Like so many of Dr. Fisher’s patients, Celso’s vascular disease was significantly advanced.

“When I first saw Joe Celso, he was in extreme pain and suffering from multiple medical problems,” said Dr. Fisher.  “His toes were gangrenous, and there were other signs of infection as well as previous debridement and non-healing wounds.”

The right leg was in the most serious condition, and Dr. Fisher’s initial endovascular attempt to resolve the blockages was not successful.  He then performed an open vascular bypass and graph procedure to restore blood flow to Celso’s extremity and was able to save the limb. 

Innovative Techniques

A few weeks later, Celso returned for an endovascular procedure to remove blockages in the left leg.  Dr. Fisher performed a left lower extremity arteriogram using an atherectomy device and retrograde pedal access to insert a balloon and stents into the affected leg arteries to remove blockages and restore blood flow to Celso’s legs. 

According to Dr. Fisher, the minimally invasive, ultrasound-guided endovascular surgery procedure is performed under local anesthesia and light sedation.

“The surgeon inserts a catheter through a small puncture in the groin artery, and in this case, in the distal pedal artery, to access the blockages in leg vessels,” he explained.  “The atherectomy device, which has a sharp blade on the end, is then inserted through the catheter to remove plaque from a blood vessel.  The balloon is inserted to help dilate the vessel and when needed a stent can be place in the artery to help keep it open.”

Approaching the blockages from both the groin and the artery in the foot is a technique that offers better access to multiple difficult blockages.

 “The minimally invasive procedure is a sound alternative to angioplasty for the treatment of peripheral vascular disease in many patients with advanced, complex disease,” said Dr. Fisher.  “The approach decreases recovery time, reduces bleeding and reduces risks for complications. 

For Joe Celso, who will soon turn 70, it is nothing short of life-changing.  “Dr. Fisher not only saved my leg, but he gave me my life back,” said Celso.  “I can walk without pain; I can mow the yard again and do things around the house.   I still have my leg and I can walk. It is incredible.”

Multidisciplinary Treatment

Peripheral artery disease (PAD) affects at least 8-12 million Americans. The disease prevalence increases with age and 12-20 percent of Americans age 65 and older have peripheral artery disease. A major hindrance to effectively treating patients with PAD is a lack of disease recognition and poor understanding of its impact on the overall health of the individual.

“Often patients with PAD also have some degree of coronary artery disease, and it is a combination that carries a very significant morbidity and mortality rate,” said Dr. Fisher, who is a national expert in lower extremity limb preservation using minimally invasive techniques.

It is common for patients with PAD to also suffer from diabetes, hypertension, infections and non-healing wounds. “It is important that we educate our patients and identify the disease early when it can most easily be medically managed in order to avoid complications and unnecessary amputations,” he said. “But it is also important to apply a multi-disciplinary approach to caring for patients with complex PAD.”

Dr. Fisher and his colleagues at TriStar Centennial are working to establish The Limb Preservation Clinic where vascular surgeons, cardiologists, podiatrists, wound care specialists and interventionists will work collaboratively with primary care physicians, infection disease and diabetes specialists to apply a holistic approach to diagnosing and treating patients with PAD.