“Last time you went through the ankle, it took 20 minutes, and you sent me home. And now you’re telling me we can do that again or you can cut my leg off?”
I’ve had patients look at me like I’m out of my mind when I present both options.
And honestly, I get it. From the patient’s perspective, the gap between what endovascular limb salvage actually feels like and what a major amputation means is so wide that offering both in the same sentence sounds absurd.
This is something Miguel and I talked about on our Case Cast with Dr. Mariano Palena. We had a 72-year-old, Rutherford 6, gangrene on the first and fifth toes with plantar involvement, referred for a BKA after open surgical exploration found nothing usable. Mariano’s team did a CO2 angiogram, recanalized the peroneal, entered the foot through the posterior branch into the lateral plantar and across the arch, and restored full perfusion. Five devices, roughly 20 minutes, outpatient-level procedure. The patient healed in three months and went back to work.
A leg that was scheduled for amputation was saved with what amounted to a same-day intervention.
Now imagine you’re that patient. You’ve already been through something similar on your other foot. You healed. You walked out. And now a different doctor is telling you the only option is to lose the leg.
That’s what barbaric looks like from the other side of the table. Not because the surgeon offering amputation is wrong in every case, but because when a 20-minute procedure exists and nobody even attempts it before making that call, something in the system has failed.
Patients already understand this. They live it. The question is whether the rest of us are willing to catch up.
