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    Sutter Heart & Vascular Institute

    Carol - New Hope for Limb Salvage

    Carol -
    Carol - New Hope for Limb Salvage

    Diagnosed with type 1 diabetes when she was 2 years old, Carol has spent her life managing her diet, monitoring her blood sugar, and dealing with complications of her disease. This includes a detached retina that led to blindness in one eye. Despite this, Carol doesn’t let diabetes slow her down. She’s a people person who loves her job as a patient-service representative.

    Sometimes, however, even careful management and a great attitude cannot overcome the toll 50 years of diabetes takes on a body. For example, diabetes damages blood vessels, reducing blood flow and often causing problems in the feet. Carol knew the risk and paid careful attention to her feet, so she was shocked when her podiatrist told her that a patch of gangrene had developed on an area of her big toe that she couldn’t see.

    Gangrene is tissue death that occurs when blood supply doesn’t reach an area. Because gangrene can progress and require foot amputation, Dr. Larsen immediately referred Carol to Sutter vascular surgeon Dr. Thomas Park.

    Dr. Park sent Carol to Dr. David Roberts for an angiogram; with the hope that he would find a blockage he could open using catheters, sparing her surgery. Unfortunately, the diabetes had caused severe damage, completely blocking all the major arteries in her leg. Restoring blood flow to her foot would require a complex bypass of a very small blood vessel far below her knee. The tiny size of the vessel made success with even surgery very uncertain. However, that was the best chance to save her foot.   Dr. Roberts sent her back to Dr. Park, assuring her that if anyone could do this bypass, he could.

    Dr. Park carefully reviewed Carol’s options. Rather than just tell her the results, Dr. Park showed Carol the images, which made it clear to her that her blood vessels couldn’t supply enough blood to her foot. Carol agreed to, and underwent bypass surgery. However, the artery was tiny, and after a few months, Dr. Park suspected the bypass had clotted. He sent her back to Dr. Roberts, who repeated her angiogram. Sadly, Dr. Park’s fears were confirmed.

    Luckily, Dr. Roberts had just started a clinical trial at Sutter Heart & Vascular Institute Research Center using stem cells to try to save legs when restoring blood flow with surgery was no longer an option. He thought Carol would be a good candidate. Unlike many clinical trials that use medical devices or drugs, this trial therapy removes some of the patient’s own bone marrow. The trial sponsor then uses this marrow to grow the patients own stem cells. These are then injected back into the patient’s leg and foot with the hope they will promote new blood vessel growth.  After Dr. Roberts carefully described this trial to her, she agreed to volunteer.

    After the injections, Carol could tell the gangrenous area was beginning to heal. And when Dr. Park examined her toe and found the gangrenous scab gone, he could hardly contain his elation. 

    Carol and her doctors have no idea if she received the trial therapy or the placebo, but they do know that her gangrene disappeared. Carol also knows that she owes the success to Dr. Larsen quickly referring her to Dr. Park, who with Dr. Roberts provided the best available care and refused to give up on her. And she knows they and Sutter Health were willing to invest precious time to take part in research they felt might help patients. However, what impressed Carol the most was the heartfelt dedication of all to providing her the best care possible. 

     

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