Penn Advanced Limb Preservation (PALP) for vascular conditions

Conditions like peripheral vascular disease affect your body’s ability to send blood to the lower extremities. In addition, diabetes impairs the ability to fight infection. These conditions can put people at high risk for foot and leg amputation.

Penn Advanced Limb Preservation (PALP) at Penn Medicine offers a team-based approach to resolving blood vessel problems with limb salvage vascular surgery. Our ultimate goal is to prevent people from losing limbs to diabetes or other disease.

What is limb preservation?

Limb preservation is a coordinated, multidisciplinary program to avoid amputation of a foot or leg. At Penn Medicine, we view limb preservation as one part of a bigger puzzle. Our PALP team helps you manage health conditions that affect blood circulation in your legs and feet.

Limb preservation eligibility for vascular patients

We treat people at high risk of losing limbs due to:

• Chronic foot or leg ulcers
• Critical limb ischemia (severe lack of blood flow)
• Diabetes, sensory loss or pressure sores
• Gangrene
• Kidney failure or end-stage kidney disease
• Claudication (lower limb cramping after walking short distances)
• Venous disorders
• Wounds that limit use of the leg
• Severe peripheral arterial disease (PAD)

Limb loss prevention services

Limb preservation is a complex effort that often requires multiple approaches. Most people at risk of losing limbs have a nonhealing sore (ulcer) or a chronic foot wound. People with diabetes are at heightened risk. Our preventive services include:

• Testing and diagnosis: We use advanced vascular testing to monitor your circulation before, during and after treatment to accurately measure your progress. Noninvasive testing such as ultrasound and CTA or MRA/MRI can reveal blood flow problems, infections and other issues.
• Wound care: Many patients come to us in an emergency situation, with an at-risk limb or chronic leg wound. Once you’re stabilized, we arrange ongoing follow-up treatment. Skilled wound care offers you a better chance at successfully healing and avoiding limb-threatening infections.
• Hyperbaric therapy: A hyperbaric chamber increases oxygen delivery to your bloodstream, which can help a wound heal. We prescribe hyperbaric therapy in some situations where we are trying to save a limb. Hyperbaric chambers are available at the Hospital of the University of Pennsylvania. If your physician prescribes hyperbaric therapy and you can’t come to Philadelphia, our team can help find a location closer to home.
• Smoking cessation: Penn Medicine’s smoking cessation program, works closely with you to help you comfortably stop smoking. Stopping smoking can make a big difference in the success of your procedure, but we know it’s hard, and we’re here to help.

Endovascular procedures to prevent amputation

Penn Medicine physicians offer advanced, minimally invasive endovascular procedures to help prevent leg amputation. Endovascular procedures do not require open incisions. Instead, physicians insert a catheter (long, narrow tube) through a tiny incision and thread it through blood vessels. At Penn, we also offer pedal access, an approach that enables us to reach challenging areas through arteries in your foot.

Minimally invasive endovascular limb preservation procedures at Penn Medicine include:

• Atherectomy: Atherectomy uses special tools to remove or reduce a fatty substance called plaque. The procedure helps to reopen blood vessels, restore blood flow and reduce vascular problems.
• Angioplasty and stenting: In angioplasty, a tiny balloon on the end of the catheter clears blood vessels. Your physician may place a stent (a small mesh tube) to hold the blood vessel open.
• Drug-coated balloons and stents: We can use stents or angioplasty balloons coated with medications that gradually release into your bloodstream. These medications prevent new plaque from forming in the area.
• Revascularization of the legs and feet: Our physicians can perform minimally invasive procedures to redirect blood flow to your legs and feet. Endovascular procedures can relieve peripheral artery disease (PAD).
• Thrombolysis: Catheter-directed thrombolysis can deliver medications or use tools to destroy a blood clot that is blocking blood flow to your lower limb.

Surgery to prevent amputation

Sometimes, an endovascular procedure isn’t appropriate. Our vascular team may have options, even if you have been turned down for surgery at another center or told you aren’t a candidate for surgery. We have the expertise to perform advanced procedures, including:

• Endarterectomy: Your surgeon makes an incision to access the blood vessel. Then, using special tools, they remove the blockage in the vessel to let blood flow freely again.
• Arterial bypass surgery: In some people with PAD, a clot or collapsed blood vessel blocks flow to the feet, causing pain and swelling. Traditional bypass surgery creates a detour around the blockage. Your surgeon stitches one end of a tiny fabric tube or vein taken from elsewhere in your body on either end of the blocked area to restore blood flow.

Limb preservation: the Penn Medicine difference

At the Penn Vascular Surgery and Endovascular Therapy Program, our limb preservation care offers:

• Trusted experts: Our experienced vascular team offers the most advanced vascular therapies available. We deliver many procedures using endovascular techniques, without surgical incisions.
• Care tailored to you: We make time to listen to you and gain an understanding of what matters most to you. Then we design a care plan to support you through tough decisions so you receive the most appropriate care.
• Team approach: Penn Advanced Limb Preservation brings together different specialists to deliver needed help. You receive care from an experienced vascular surgeon. Your team may also include an expert podiatrist, interventional cardiologist, interventional radiologist, wound care specialist and an endocrinologist to help you stay on top of your blood sugar levels.
• State-of-the-art technology: We deliver heart and vascular care in new facilities. Your doctors have the latest diagnostic, surgical and endovascular technology at their fingertips.
• Clinical trials: Because Penn Medicine is an academic medical center, you have access to many types of clinical trials. These investigational treatments and approaches offer options that aren’t available at all centers.

Follow-up care

Limb preservation is an ongoing process. The Penn Medicine vascular team believes in giving you a solution that will work for you over time. You can receive needed follow-up care from Penn Advanced Limb Preservation doctors at satellite locations closer to your home.