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March 4, 2024
MARSHFIELD – The vascular department at the Marshfield Clinic is offering a new and recently FDA-approved surgical procedure for a unique subset of patients with end-stage chronic limb-threatening ischemia (CLTI) – a severe condition that increases the risk for limb loss or major amputation due to reduced blood flow.
CLTI is a condition in which there is severe blockage of blood flow to one or multiple hands, legs or feet causing intense pain accompanied by a high risk of heart complications and amputation.
LimFlow was approved by the FDA last September in the treatment of final-stage CLTI.
The Marshfield vascular team, led by Dr. Ayman Ahmed, conducted its first LimFlow procedure in December – making them the first in Wisconsin to perform the procedure.
Ahmed said company representatives of LimFlow were on site in Marshfield during the procedure and provided ongoing support and follow-up after the surgery.
The LimFlow procedure restores blood flow to a patient’s foot who is dealing with CLTI.
Ahmed said LimFlow is a significant breakthrough for patients with end-stage CLTI who are otherwise likely to have a major amputation.
According to the LimFlow website (limflow.com), LimFlow transcatheter arterialization of the deep veins system is a treatment option designed to restore blood flow to the ischemic foot when all other options have been exhausted.
Ahmed said the training and support from the LimFlow team, as well as other vascular surgeons, has been enlightening.
“I went to an advanced endovascular course that was held by the vascular surgeon where the LimFlow was part of the data (collections),” he said
The instruction, Ahmed said, included both formal and hands-on sessions – as well as many resources with whom they can consult, namely other surgeons who have performed LimFlow procedures.
“We can send any inquiries about our patients as candidates, as they go through the procedure or in their recovery to the company and the experts in the field,” he said. “We evaluate patient data and images and they can give their opinions. It is overall a good reporting system.”
An innovative procedure
Ahmed said surgical candidates for LimFlow are “evaluated with care” as this procedure is not appropriate for all patients.
“It is a subset of patients who would be considered,” he said. “I tell patients this is a journey.”
That road, Ahmed said, began for most patients with long-term vascular issues that are evaluated over time.
“There is a small arterial capillary bed or small vessels at the level of the foot that are damaged through sclerotic disease,” he said. “In these cases, patients will not have further options through the traditional vascular reconstructive approaches.”
Ahmed said the LimFlow procedure is an innovative way of using a substitute network at the foot level to provide the blood flow with oxygen and nutrients to the foot tissue.
“This technique connects the artery below the knee to the vein,” he said. “(We) then go to the foot and force the vein to become an artery and use the vein network at a foot level as a new arterial network that will take the blood down to the foot.”
Ahmed said what’s unique about the venous system is that it brings the blood back to the heart.
“It’s an extensive network so we use only one of these veins, or few of them to convert them into arteries because the arterial side of that blood vessel network of the foot has been damaged,” he said.
Ahmed said discussing LimFlow as an alternative approach to amputation for a select patient group is the focus.
“We are (not) providing this procedure as a substitute for something else,” he said. “It’s more like can (we) provide this procedure as a hope to avoid major amputation. That’s why it’s appealing.”
That being said, Ahmed said the outcome of preserving the limb is not 100%.
“I tell my patients, ‘you’re going to hear about this procedure, and it is promising and appealing, but it’s a journey and it’s not a 100% guarantee,’” he said. “But the studies show it can be up to a 70% chance of preserving your limb, which, (when) compared to 0% is a decent number.’”
The treatment path, Ahmed said, is about six weeks to two months.
A comprehensive field
The vascular team at the Marshfield Clinic, Ahmed said, includes four surgeons, four advanced practice clinicians, five medical assistants and six vascular lab technicians – all working in concert to serve patients throughout Wisconsin.
Ahmed said the team travels to surrounding communities bringing care to Michigan’s Upper Peninsula, Eau Claire and Minocqua.
“I think Marshall Clinic has been working hard in accomplishing its mission and bringing affordable care close to home, including cutting-edge technology and investment,” he said.
Ahmed is originally from Sudan and attended medical school at the University of Khartoum, the oldest and most competitive medical school in Sudan.
He came to the United States for his residency and spent a year at the Mayo Clinic in Rochester and the University of Minnesota.
Ahmed finished his general surgery residency at the University of California in San Francisco and then completed his two-year fellowship in vascular training at the Cleveland Clinic in Ohio.
Ahmed said he’s always had a keen interest in vascular surgery.
“Vascular surgery is a comprehensive field equipping (one) with a different set of skills, including surgical, medical and radiological to provide care for your patients,” he said. “We have a long-term relationship with the vast majority of our patients, which is unique to the vascular specialty. It requires a different (skillset) than a regular surgical patient who comes in for an appendix. Vascular surgery requires a fine set of surgical skills because you’re dealing with a delicate type of tissue, which are the vessels, which we repair and reconstruct.”
Ahmed said technology is growing exponentially and having an impact on procedure times and lengths of hospital stays.
“What took an average of four to six hours can now be done within an hour or two,” he said. “Instead of staying five to seven days in the hospital, the patient stays overnight and goes home the following day.”
Ahmed said there is a great shortage of vascular surgeons in the United States impacting this area of medicine.
“The longer (people) live depending on a healthy lifestyle, the more likely they will end up with some vascular problems that need somebody to take care of, increasing the vascular patient population,” he said.
Close-to-home care
Ahmed said there are numerous benefits to bringing technology to this part of Wisconsin.
“I think the Marshfield Clinic has been working hard in accomplishing its mission and bringing affordable care close to home, including cutting-edge technology and investment (in it).”
Specifically with LimFlow, Ahmed said it is providing new hope for a selected group of patients who did not have options before.
“We are blessed with a well-integrated and comprehensive vascular department here, and I know my partners and my team are there for support and committed to what they do for the patients,” he said.
To learn more about LimFlow and the Marshfield Clinic vascular surgery department, visit marshfieldclinic.org.
