Teaming Up to Save Limbs at the Inova Center for Personalized Health

Richard F. Neville, MD, is associate director of the Inova Heart and Vascular Institute (IHVI), vice chairman of Surgical Sub-specialties and director of Vascular Services. He is board-certified in vascular surgery. Read Dr. Neville’s profile.

I recently treated a patient – a former government ambassador – who was suffering from blocked arteries in his leg, a complication of diabetes. He’d already had one procedure to improve blood flow in his leg, but it was unsuccessful. His doctors had suggested amputation, but he came to me for a second opinion.

I performed bypass surgery to restore blood flow, and we were able to save his foot.

As a vascular surgeon, I often see patients faced with the difficult decision of whether to have a limb amputated. At Inova, we’re creating a state-of-the-art program to help more patients avoid that outcome.

Limb-Saving Surgeries

When I began my career three decades ago, I was troubled to see how many patients lost lower limbs to vascular disease (diseases that affect blood vessels and impair blood flow). Many of those patients had complications from diabetes, while others suffered from problems, such as heart disease or atherosclerosis (hardening of the arteries).

Patients in this situation have two options to improve blood flow and save their limbs. One approach is endovascular therapy, a minimally invasive technique that uses catheters to help open the blocked arteries. Another approach is surgical bypass, in which we reroute the blood vessels to restore blood flow to the leg.

Over the years, I’ve helped develop new and improved techniques to make such bypass surgeries even more effective. But in the process, I’ve realized that it takes more than just the surgeon to save a limb – it takes a team.

In my previous positions at Georgetown University and George Washington, I spearheaded a team-based approach that brings together a variety of medical specialists to treat patients with the health problems that contribute to limb loss. I’m so passionate about this approach that earlier this year, I decided to bring this philosophy to Inova to develop a world-class limb-preservation program as part of the new Inova Center for Personalized Health.

Preventing and Treating Vascular Disease

While I’m pleased to be able to offer the latest surgical options to my patients, surgery should be a last resort. For that reason, much of our program is focused on preventing serious vascular disease. Our goal is to identify patients at risk of vascular disease, screen them for problems and offer preventive care and medical therapy, so they can avoid serious blood-flow problems.

If patients do reach a point where they need surgery, however, we offer a full range of endovascular therapy and surgical bypass options.

After I do my part, however, other members of the team step up to play equally important roles. Those experts can include:

• Plastic surgeons, general surgeons or podiatrists who are experts in helping soft tissues heal
• Infectious disease specialists who can address hard-to-treat infections
• Specialists, such as nephrologists and cardiologists, who can treat the kidney and heart disorders that often coincide with vascular disease
• Prosthetics specialists and rehabilitation specialists who can help patients get back on their feet after surgery in their legs

Clinical Care, Research and Education

I decided to come to work at Inova because I wanted to help more patients avoid limb amputation – and I believe this is the best place to do that. Not only does Inova offer a strong clinical treatment program, but it also has a renewed commitment to research and education.

To further our mission, for example, we’ve begun granting limb fellowships to train doctors in better methods for preserving limbs. We’re one of a handful of institutions in the country that offer such fellowship opportunities.

Sometimes, amputation is the best option for our patients – but it shouldn’t be the only option. By bringing together a team of experts, we can reduce the need for amputation and help patients stand on their own two feet.

Learn more about the Inova Heart and Vascular Institute.