Here’s the bad news in Dr. Azher Iqbal’s world of vascular medicine: obesity and diabetes have contributed in large part to more than 480 amputations in Erie County in 2014, the most recent year for which statistics are available.
More than 460 of them involved a lower limb, an average hospital stay of 12.2 days and an average $52,313 charge per patient.
Here’s the good news: Advancements in his field have helped bring new technology to Western New York that can save you an arm or leg.
“Amputation is not a treatment. It’s a failure of treatment,” said Iqbal, a New York City native who moved to Buffalo 15 years ago and has become one of the pioneers at Gates Vascular Institute on the Buffalo Niagara Medical Campus.
Related story – Dr. Azher Iqbal’s work at Gates Vascular Institute
Iqbal, 55, of Orchard Park, is section chief of vascular interventional radiology at Buffalo General Medical Center and Gates Vascular Institute, co-chair of the Save a Leg, Save a Life Foundation, and assistant clinical professor of radiology at the University at Buffalo School of Medicine and Biomedical Sciences.
He will host a grand opening from 9 to 11 a.m. Wednesday of his new office, Vascular Interventional Associates, at 6337 Transit Road in Lancaster – a space where he can perform outpatient procedures to open closed blood vessels and save limbs endangered by peripheral artery disease, which impacts one in 10 adult Americans and can cause ulcers and opened wounds. Those, in turn, can require amputations.
People with diabetes are particularly endangered.
“The loss of a limb is very, very costly to a health care system and has a devastating effect on patients,” Iqbal said. “About 75 percent of patients who undergo below knee amputation never get fitted for a prosthesis. The numbers are even more dire for above knee amputation – less than 15 percent ever get fitted for a prosthesis. What we are creating are patients who are limited in mobility or bed-ridden, depressed.
“The five-year mortality rate for patients who have had amputations is abysmal. It’s over 50 percent. They also undergo an amputation of the other leg at about the same rate. It almost turns into a spiral. It’s a very sad end to life.”
It doesn’t have to be this way, Iqbal said.
“Ten percent of the population has peripheral artery disease,” he said. “Only about 1 to 2 percent are diagnosed and out of those, less than half a percent are treated."
His 6,000-square-foot space is designed to address the disparity. It includes four accredited vascular lab rooms, a recovery area and seven exam rooms with “anatomy boards.” The computerized boards display 3-D images of the body and allow Iqbal and clinical coordinator Blanka Heary, with the swipe of a finger, to peel away the skin and muscles on the screen and expose the arteries and nerves. Patients can see where the blood flow stops and how Iqbal is going to fix matters.
He can then perform catheterization procedures in the office endovascular suite using guided imagery to clear blocked arteries in the arms, pelvis and, mostly commonly, legs.
Q. The lack of blood flow in many cases of the legs can lead to amputation?
Traditionally, when someone comes to a physician with a non-healing ulcer or near gangrene, according to the latest numbers from the American Vascular Society, about half these patients will get an amputation without the benefit of an angiogram, a study of blood vessels to see where a problem might be. Amputation is done as a primary “treatment.” Over the last five years, a revolution has taken place with the miniaturization of devices and endovascular techniques. As a result, we are now able to open small arteries down to the foot. These procedures are done in the comfort of operation space and a patient goes home a couple hours afterwards. A patient does not have any risk of general anesthesia. It’s done with local anesthesia and IV sedation.
With that in mind, we started doing this at Buffalo General Hospital and slowly an informal team has emerged to help heal wounds. The team concept is to get people who are generally passionate about healing wounds from different specialties who can work with each other. People who are in infectious disease and can suggest the appropriate antibody coverage and try to treat that wound. People from podiatry who are the cornerstones, who treat most of the patients as first-line physicians. People from endocrine who treat patients with diabetes. Then we have the endovascular experts who bring blood into the area that needs it the most.
Most patients with peripheral artery disease will walk around with major arteries which are blocked. That’s fine until an area of the foot turns into an ulcer or a wound. Once that happens, if they don’t get increased blood flow, there’s not enough oxygen and nutrients and that ulcer becomes worse and worse. It turns to gangrene and ultimately amputation. The goal is to bring that patient in as soon as that ulcer is identified.
Time-wise, if an ulcer has not healed in four weeks, they should be seen by a vascular specialist right away. Once we’ve seen that patient, we’ll do the appropriate vascular workup – typically an MRI, a CT or an angiogram – and take the patient for a revascularization. All this is done within a few days, depending on the severity of the ulcer. Once you get the blood flow going to the area that needs it the most, that ulcer will heal dramatically and rapidly.
Q. How long does a procedure last and what’s recovery like?
It can take anywhere from a half-hour to three hours, depending on how complex. Most are about an hour and a half. Most patients are in recovery for a couple of hours and can go home. We make sure that once a patient is getting blood to an area that needs blood, that patient is hooked up with a very good wound care professional, their blood sugars are controlled and they’re on an appropriate diet. That they’re seeing a podiatrist that will give them proper foot care. It used to be that with other methods, treatment of ulcers might last months, maybe even years. This way, patients can get better in a matter of a few weeks, depending on the severity of their wound.
The biggest challenge I find in Western New York is changing the old habits of care providers. What I’ve been doing is putting on a symposium from an educational foundation. Our 10th anniversary symposium is Oct. 1 in Amherst (register at viabuf.com). We get specialists from around the country who come in and educate. We expect about 175 or so local providers and podiatrists. Tuition is complimentary through the foundation and you get 5 hours of continuing educational credits from the University at Buffalo School of Medicine.
Twitter: @BNrefresh, @ScottBScanlon